Form Fms 210co - Designation For Certifying Officer - Kansas City Financial Center Page 2
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1
2Instructions for Form FMS 210CO
1.
This form is for use in designating Certifying Officers (CO) who will have authority to certify payment requests, for
specific Agency Location Codes (ALCs), to the Financial Management Service, for payment. Such designations
are valid for a period of two years from the effective date. At the end of that period they will expire, unless a
re-designation is submitted to the Financial Management Service. This form may be used for original designations,
re-designations and revocations.
2.
Only one individual may be designated authority or revoked per form.
Section I
List all Agency Location Codes (ALCs) that the designee will have authority to certify payments for.
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Enter pertinent information in the Comments field, such as Designee Name Change, FPAID, etc.
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List all application(s) for which this designation will be applicable.
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Check the appropriate block for “Type of Designation or Revocation Action”. Only one block may be checked.
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- Check “Original Designation” for new designations.
- Check “Re-Designation” for renewals of existing designations.
- Check “Revocation” to revoke all authority that was originally designated. If partial authority is to be
retained from the original designation, a new form FMS 210CO must be received re-designating that
authority.
Section II
The Full Legal Name of the designee must be entered for designee name.
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For “Effective Date” enter the date that the designation is to be effective on. Designations are good for a
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period of two years from the effective date. The actual effective date will be the latter of, the requested
effective date and the date the designation is actually accepted by FMS.
Section III
Designee must sign within all four boxes.
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All signatures must be handwritten originals.
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All signatures must be clearly legible in BLACK INK for reproduction purposes.
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Designee must sign in the same manner as he/she will be using on future documents to be submitted to FMS.
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Section IV
All forms FMS 210CO must be signed in this section by an authorized designator, whose authority is
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substantiated by a valid form FMS 2958, on file with FMS.
Signature must be within the box and clear and legible, using BLACK INK for reproduction purposes.
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An accomplished copy of form FMS 210CO will be returned directly to the designator, at the address specified
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in Section V.
Designators are cautioned to review accomplished copies to ensure no changes to form FMS 210CO have
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occurred between signature and acceptance by FMS.
Section V
Must be completed to reflect the return address of the designator signing in Section IV.
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Section VI
Will be completed by FMS.
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If accomplished date is later than the effective date, the accomplished date will become the effective date.
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