FEDLINK IAG ACCOUNT ADJUSTMENT AMENDMENT
TERMINATE SERVICES/FUNDS or REFUND

Use this form to terminate a service and/or request a refund from a Transfer Pay Account.
 (Step-by-Step Instructions)

Enter the fiscal year in the box below and then complete the remaining sections.
Fiscal Year (One form per fiscal year)

B: TERMINATE SERVICE for Transfer Pay Account (Be sure the account balance is zero.)
Service ID and Name
Transfer
Transfer
I authorize FEDLINK to terminate the services provided under my IAG from the vendor specified above.
I certify that, as of the date of this request, my agency will no longer place orders with or use the service of the above vendor under the LC/FEDLINK BOA. Any additional charges accured will be responsibility of my agency.
I will complete Section C to instruct FEDLINK on how to handle any funds remaining in the terminated service account.
C: REFUND FUNDS for Transfer Pay Account
Account Service ID and Name Action Service Dollars Amount
(No Commas)
Transfer Refund $
Transfer Refund $
Transfer Refund $
Transfer Refund $
Transfer Refund $
Transfer Refund $
Transfer Refund $
Transfer Refund $
Total Decrease $
Certification : I certify that I have checked with the vendor and that the balance for the above service account(s) (after funds are removed or refunded) will be sufficient to cover all outstanding and projected usage of the service(s) for the fiscal year indicated. My agency is responsible for any additional charge accured under the LC/FEDLINK BOA.
Refund Address: Please do not send the refund to the point of contact address on my agency's IAG. Instaed, send the refund to the following address:


D: SIGNATURE (Complete all required yellow fields.)
I understand and accept the policies and procedures for using FEDLINK services as described in the current FEDLINK Registration Booklet and Member Handbook. I authorize LC/FEDLINK to amend my IAG to adjust my existing pay service accounts and to begin new services where specified. Submitting this request form does not change my agency's obligation to the Library of Congress under the IAG, but my authorization does initiate changes in the allocation of funds among services. I also confirm the certifications required above.
Full Name Phone (work)
FEDLINK ID Password
Signature: Date:

Please only hit the submit button once. If you hit the submit button twice it may cause duplicate posting to your account. If you are having problems please contact the FEDLINK Fiscal Hotline at (202)707-4900.