Form NIH-649-1 Shipping/Transfer Order & Receipt Document

Form NIH-649-1 is a U.S. Department of Health and Human Services - National Institutes of Health form also known as the "Shipping/transfer Order & Receipt Document". The latest edition of the form was released in March 1, 2013 and is available for digital filing.

Download an up-to-date fillable Form NIH-649-1 in PDF-format down below or look it up on the U.S. Department of Health and Human Services - National Institutes of Health Forms website.

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1. DOC. NO. & DATE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
SHIPPING/TRANSFER ORDER & RECEIPT DOCUMENT
CONTRACT PROPERTY
THIS FORM WILL BE USED FOR ALL SHIPMENTS/TRANSFERS OF GOVERNMENT PROPERTY
NOTE:
INTO AND OUT OF NIH CONTRACTS. FOR OTHER TRANSFERS USE FORM NIH649.
PAGE 1 OF
PAGES
2. INSTRUCTIONS TO CONSIGNOR
3. INSTRUCTIONS TO CONSIGNEE
Acknowledge receipt of property by signing
2a. Ship listed property to consignee by the safest and most
Block 10 below. List all exceptions separately.
economical mode of transportation (See Blocks 5 & 8 below)
DO NOT MAKE CHANGES ON THIS DOCUMENT.
2b. Release listed property to consignee who will
Return only last copy of this form.
arrange transportation.
Return all other copies to:
National Institutes of Health
2c. Transfer listed property to contract Indicated in
Attn: Research Contracts Property Admin.
Block 8b. No movement involved.
Bldg.
Room
2d. Transfer listed property to consignee.
9000 Rockville Pike
No movement involved.
Bethesda, MD 20892
4. PAYMENT OF SHIPPING CHARGES WILL BE
5. SHIPPING ADDRESS (Consignee Destination)
Paid by consignor who may bill the government
4a. PREPAID
under contract indicated in Block 7b.
Paid by consignee who may bill the government
4b. COLLECT
under contract indicated in Block 8b.
Paid by government under GBL after receipt
4c. GBL-COLLECT
of shipment. (See Block 6 below)
6. Carriers should forward freight bill and bill of lading to National Institutes of Health,
6a. CAN TO BE CHARGED
Shipping & Receiving, Building 13, Room 13001, 9000 Rockville Pike, Bethesda, MD
20892. Phone (301) 496-6028
To expedite payment, refer to this account no.
7. TRANSFERRED FROM (Consignor)
8. TRANSFERRED TO (Consignee)
7a. *CONTRACTOR (OR ICD) SEE BLOCK 7h.
8a. CONTRACTOR (OR ICD)
7b. CONTRACT NO.
7c. CUSTODIAL CODE PIN
8b. CONTRACT NO.
8c. CUSTODIAL CODE PIN
8e. AFFIX ENCLOSED DECALS
7d. AUTHORITY
7e. PLT. CLEAR CASE (PCC)
8d. MARK FOR
EXACTLY AS SHOWN BELOW
7f. PROPERTY ADMIN.
7g. DATE
8f. PROPERTY ADMIN.
8g. DATE
*7h. CONSIGNOR CERTIFIES THAT THE PROPERTY LISTED BELOW IS FREE FROM ALL HAZARDS
INCLUDING BIOLOGICAL, CHEMICAL, AND RADIOACTIVE CONTAMINATION.
MFGR.
NIH
ACQUISITION
ITEM
DESCRIPTION.
QUANTITY
COND.
SERIAL NO.
PROPERTY NO
COST
NO. 9a.
9b.
9c.
CODE 9f.
(INCLUDE NSN, MFGR, MODEL, TYPE, CAPACITY, DIMENSIONS, ETC.)
9d.
9e.
9g.
10. RECEIVING DATA (Consignee)
11. NIH PROCESSING DATA
12. COST DATA
RECEIPT IS
PROP
SIGNATURE & TITLE
BY
DATE
TOTAL NOR
TOTAL G/L
GRAND TOTAL
ACKNOWLED-
ACCT
GED EXCEPT
PROP
BY
DATE
AS NOTED
$
$
$
UTIL
13. Consignor is hereby relieved from accountability for
SIGNATURE
DATE
listed property under contract indicated in Block 7b.
NIH 649-1 (Rev. 03/13)
1. DOC. NO. & DATE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
SHIPPING/TRANSFER ORDER & RECEIPT DOCUMENT
CONTRACT PROPERTY
THIS FORM WILL BE USED FOR ALL SHIPMENTS/TRANSFERS OF GOVERNMENT PROPERTY
NOTE:
INTO AND OUT OF NIH CONTRACTS. FOR OTHER TRANSFERS USE FORM NIH649.
PAGE 1 OF
PAGES
2. INSTRUCTIONS TO CONSIGNOR
3. INSTRUCTIONS TO CONSIGNEE
Acknowledge receipt of property by signing
2a. Ship listed property to consignee by the safest and most
Block 10 below. List all exceptions separately.
economical mode of transportation (See Blocks 5 & 8 below)
DO NOT MAKE CHANGES ON THIS DOCUMENT.
2b. Release listed property to consignee who will
Return only last copy of this form.
arrange transportation.
Return all other copies to:
National Institutes of Health
2c. Transfer listed property to contract Indicated in
Attn: Research Contracts Property Admin.
Block 8b. No movement involved.
Bldg.
Room
2d. Transfer listed property to consignee.
9000 Rockville Pike
No movement involved.
Bethesda, MD 20892
4. PAYMENT OF SHIPPING CHARGES WILL BE
5. SHIPPING ADDRESS (Consignee Destination)
Paid by consignor who may bill the government
4a. PREPAID
under contract indicated in Block 7b.
Paid by consignee who may bill the government
4b. COLLECT
under contract indicated in Block 8b.
Paid by government under GBL after receipt
4c. GBL-COLLECT
of shipment. (See Block 6 below)
6. Carriers should forward freight bill and bill of lading to National Institutes of Health,
6a. CAN TO BE CHARGED
Shipping & Receiving, Building 13, Room 13001, 9000 Rockville Pike, Bethesda, MD
20892. Phone (301) 496-6028
To expedite payment, refer to this account no.
7. TRANSFERRED FROM (Consignor)
8. TRANSFERRED TO (Consignee)
7a. *CONTRACTOR (OR ICD) SEE BLOCK 7h.
8a. CONTRACTOR (OR ICD)
7b. CONTRACT NO.
7c. CUSTODIAL CODE PIN
8b. CONTRACT NO.
8c. CUSTODIAL CODE PIN
8e. AFFIX ENCLOSED DECALS
7d. AUTHORITY
7e. PLT. CLEAR CASE (PCC)
8d. MARK FOR
EXACTLY AS SHOWN BELOW
7f. PROPERTY ADMIN.
7g. DATE
8f. PROPERTY ADMIN.
8g. DATE
*7h. CONSIGNOR CERTIFIES THAT THE PROPERTY LISTED BELOW IS FREE FROM ALL HAZARDS
INCLUDING BIOLOGICAL, CHEMICAL, AND RADIOACTIVE CONTAMINATION.
MFGR.
NIH
ACQUISITION
ITEM
DESCRIPTION.
QUANTITY
COND.
SERIAL NO.
PROPERTY NO
COST
NO. 9a.
9b.
9c.
CODE 9f.
(INCLUDE NSN, MFGR, MODEL, TYPE, CAPACITY, DIMENSIONS, ETC.)
9d.
9e.
9g.
10. RECEIVING DATA (Consignee)
11. NIH PROCESSING DATA
12. COST DATA
RECEIPT IS
PROP
SIGNATURE & TITLE
BY
DATE
TOTAL NOR
TOTAL G/L
GRAND TOTAL
ACKNOWLED-
ACCT
GED EXCEPT
PROP
BY
DATE
AS NOTED
$
$
$
UTIL
13. Consignor is hereby relieved from accountability for
SIGNATURE
DATE
listed property under contract indicated in Block 7b.
NIH 649-1 (Rev. 03/13)

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