GSA Form 3661 "Purchase Card Application and Maintenance"

What Is GSA Form 3661?

This is a legal form that was released by the U.S. General Services Administration on March 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2018;
  • The latest available edition released by the U.S. General Services Administration;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of GSA Form 3661 by clicking the link below or browse more documents and templates provided by the U.S. General Services Administration.

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Download GSA Form 3661 "Purchase Card Application and Maintenance"

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PURCHASE CARD APPLICATION AND MAINTENANCE
PRIVACY ACT STATEMENT: This information is subject to the Privacy Act of 1974 (5 U.S.C. 552a). Collection of this information is authorized by 41 U.S.C.
252a, 252b, 427, 428; E.O. 12931, and Section 639 of the Consolidated Appropriations Act, 205 (P.L. 108-447) for managing the GSA purchase card program.
SECTION I - TYPE OF ACTION - A, B, C, D, or E
A. New Account
B. Cancel Account
C. Approving Official (AO) Changes
D. Reconciler Changes
E. Change Account
D1. ADD NEW
C1. NEW AO REPLACES FORMER AO ON ALL ASSOCIATED
E1. DOLLAR LIMIT CHANGE
CARDS (Complete Sections IV and VI.)
E2. NAME CHANGE (INCLUDE PREVIOUS NAME)
D2. REPLACE CURRENT
C2. NEW AO REPLACES FORMER AO ON A SINGLE
E3. ADDRESS CHANGE
E4. DEFAULT CODE CHANGE
CARD (Complete Sections II, IV, and VI.)
E5. AUTHORIZE
D3. REMOVE CURRENT
CONVENIENCE CHECKS (OIG Only)
(NOTE: NEW CARDHOLDERS AND APPROVING OFFICIALS MUST COMPLETE REQUIRED TRAINING AND ATTACH CERTIFICATES OF
COMPLETION. WARRANTED CONTRACTING OFFICERS MUST ATTACH A COPY OF THEIR WARRANT).
SECTION II - CARDHOLDER (Use payroll name)
VERIFICATION CODE
OFFICE SYMBOL
Name
LAST
FIRST
MIDDLE INITIAL
FORMER LAST NAME
OFFICE STREET ADDRESS (Including Room Number)
CITY
STATE
ZIP CODE (+ 4 if known)
BUSINESS TELEPHONE NUMBER
CARDHOLDER'S GSA E-MAIL ADDRESS
I certify that I have successfully completed the GSA online university training for the Purchase Card (attach completion
certificate).
I also certify that I have completed the Pegasys charge card training or read the Pegasys charge card
User Guide
and understand how to log and reconcile purchase card transactions in Pegasys.
DATE
SIGNATURE
SECTION III - PRIVILEGES AND CODING
MONTHLY PURCHASE LIMIT ($)
SINGLE PURCHASE LIMIT ($)
SUB-
FUND
PROGRAM
ACTIVITY
Pegasys
REGION
ORGANIZATION
OBJECT
PROJECT
BUILDING NUMBER
CODE
CODE
CODE
Default
CLASS
Coding
SECTION IV - APPROVING OFFICIAL
NAME OF NEW APPROVING OFFICIAL (AO)
OFFICE SYMBOL
GSA E-MAIL ADDRESS
OFFICE STREET ADDRESS
BUSINESS TELEPHONE NUMBER
CITY
STATE
ZIP CODE (+ 4 if known)
NAME OF FORMER APPROVING OFFICIAL (If applicable)
I certify that I am not subordinate to the above cardholder and will ensure that the purchase card is used properly in
accordance with all purchase card policy and procedures.
DATE
SIGNATURE
SECTION V - ACCOUNTING TRANSACTION RECONCILER (Optional - Most cardholders reconcile their own entries)
OFFICE SYMBOL
NAME
AUTHORIZE THIS
TURN ON DAILY E-MAIL
PERSON ACCESS TO
CARDHOLDER'S
NOTIFICATION OF NEW
PEGASYS CREDIT
GSA E-MAIL ADDRESS
NAME OF FORMER RECONCILER
CHARGES
CARD RECONCILIATION
NOTEBOOK
SECTION VI - SIGNATURES
REQUESTING OFFICIAL
SIGNATURE
DATE
(Division Director or
higher) I certify that a
subordinate is not serving
TYPED OR PRINTED NAME OF SIGNER
TYPED OR PRINTED TITLE OF SIGNER
as an approving official for
their direct supervisor.
FUNDS MANAGER
SIGNATURE
DATE
(Required for new
cardholder setup, default
accounting code changes
TYPED OR PRINTED NAME OF SIGNER
and purchase limit
changes)
LEVEL TWO
LEVEL THREE
LEVEL FOUR
FOR COORDINATORS USE ONLY
GSA 3661 (REV. 3/2018)
GENERAL SERVICES ADMINISTRATION
PURCHASE CARD APPLICATION AND MAINTENANCE
PRIVACY ACT STATEMENT: This information is subject to the Privacy Act of 1974 (5 U.S.C. 552a). Collection of this information is authorized by 41 U.S.C.
252a, 252b, 427, 428; E.O. 12931, and Section 639 of the Consolidated Appropriations Act, 205 (P.L. 108-447) for managing the GSA purchase card program.
SECTION I - TYPE OF ACTION - A, B, C, D, or E
A. New Account
B. Cancel Account
C. Approving Official (AO) Changes
D. Reconciler Changes
E. Change Account
D1. ADD NEW
C1. NEW AO REPLACES FORMER AO ON ALL ASSOCIATED
E1. DOLLAR LIMIT CHANGE
CARDS (Complete Sections IV and VI.)
E2. NAME CHANGE (INCLUDE PREVIOUS NAME)
D2. REPLACE CURRENT
C2. NEW AO REPLACES FORMER AO ON A SINGLE
E3. ADDRESS CHANGE
E4. DEFAULT CODE CHANGE
CARD (Complete Sections II, IV, and VI.)
E5. AUTHORIZE
D3. REMOVE CURRENT
CONVENIENCE CHECKS (OIG Only)
(NOTE: NEW CARDHOLDERS AND APPROVING OFFICIALS MUST COMPLETE REQUIRED TRAINING AND ATTACH CERTIFICATES OF
COMPLETION. WARRANTED CONTRACTING OFFICERS MUST ATTACH A COPY OF THEIR WARRANT).
SECTION II - CARDHOLDER (Use payroll name)
VERIFICATION CODE
OFFICE SYMBOL
Name
LAST
FIRST
MIDDLE INITIAL
FORMER LAST NAME
OFFICE STREET ADDRESS (Including Room Number)
CITY
STATE
ZIP CODE (+ 4 if known)
BUSINESS TELEPHONE NUMBER
CARDHOLDER'S GSA E-MAIL ADDRESS
I certify that I have successfully completed the GSA online university training for the Purchase Card (attach completion
certificate).
I also certify that I have completed the Pegasys charge card training or read the Pegasys charge card
User Guide
and understand how to log and reconcile purchase card transactions in Pegasys.
DATE
SIGNATURE
SECTION III - PRIVILEGES AND CODING
MONTHLY PURCHASE LIMIT ($)
SINGLE PURCHASE LIMIT ($)
SUB-
FUND
PROGRAM
ACTIVITY
Pegasys
REGION
ORGANIZATION
OBJECT
PROJECT
BUILDING NUMBER
CODE
CODE
CODE
Default
CLASS
Coding
SECTION IV - APPROVING OFFICIAL
NAME OF NEW APPROVING OFFICIAL (AO)
OFFICE SYMBOL
GSA E-MAIL ADDRESS
OFFICE STREET ADDRESS
BUSINESS TELEPHONE NUMBER
CITY
STATE
ZIP CODE (+ 4 if known)
NAME OF FORMER APPROVING OFFICIAL (If applicable)
I certify that I am not subordinate to the above cardholder and will ensure that the purchase card is used properly in
accordance with all purchase card policy and procedures.
DATE
SIGNATURE
SECTION V - ACCOUNTING TRANSACTION RECONCILER (Optional - Most cardholders reconcile their own entries)
OFFICE SYMBOL
NAME
AUTHORIZE THIS
TURN ON DAILY E-MAIL
PERSON ACCESS TO
CARDHOLDER'S
NOTIFICATION OF NEW
PEGASYS CREDIT
GSA E-MAIL ADDRESS
NAME OF FORMER RECONCILER
CHARGES
CARD RECONCILIATION
NOTEBOOK
SECTION VI - SIGNATURES
REQUESTING OFFICIAL
SIGNATURE
DATE
(Division Director or
higher) I certify that a
subordinate is not serving
TYPED OR PRINTED NAME OF SIGNER
TYPED OR PRINTED TITLE OF SIGNER
as an approving official for
their direct supervisor.
FUNDS MANAGER
SIGNATURE
DATE
(Required for new
cardholder setup, default
accounting code changes
TYPED OR PRINTED NAME OF SIGNER
and purchase limit
changes)
LEVEL TWO
LEVEL THREE
LEVEL FOUR
FOR COORDINATORS USE ONLY
GSA 3661 (REV. 3/2018)
GENERAL SERVICES ADMINISTRATION
DELEGATION OF PROCUREMENT AUTHORITY FOR MICRO-PURCHASE CARDHOLDERS: You are delegated to
purchase authorized supplies and services with the Government purchase card, not to exceed your single purchase limit. All
purchases must be made in accordance with applicable laws and regulations including, but not limited to, the Federal
Acquisition Regulation (FAR), the GSA Acquisition Manual (GSAM), and other GSA policy. This delegation shall terminate
upon separation from the agency, upon assignment to another GSA organization, or upon cancellation of the purchase card
account.
Below are instructions to complete the form. The form will be returned if applicable fields are omitted. Digital signatures are
acceptable.
Section I - Type of Action
A. New Account - Complete Sections, II, III, IV, and VI. Select Section V if cardholder is using a reconciler to log transactions in
Pegasys.
B. Cancel Account - Complete Sections II and VI. (The signature of the Funds Manager is not required. An e-mail is
acceptable to cancel the purchase card).
C. Approving Official (AO) Changes - Select option C1 or C2. Follow the instructions on the form for the selected option.
D. Reconciler Changes - Select option D1, D2, or D3. Also complete Sections II, V, and VI. (The signature of the Funds
Manager is not required. An e-mail is acceptable to remove a reconciler).
E. Change Account - Select option 1, 2, 3, 4, or 5.
E1. Dollar Limit Change - Complete section II, III, and VI.
E2. Name Change - Complete section II and VI (the signature of the Funds Manager is not required).
E3. Address Change - Complete section II and VI (the signature of the Funds Manager is not required).
E4. Default Code Change - Complete section II, III, and VI.
E5. Convenience Checks - Subject to approval by OAS for emergency preparedness (excludes OIG).
Section II - Cardholder
1. Use the name as listed in CHRIS. Complete the fields, sign, and date.
2. Verification Code - the last four digits of your business telephone number. Use this code as your identification when you
contact the Citibank helpdesk.
Section III - Privileges and Coding
1. Micro-purchase cardholders:
Single purchase limit:
Monthly purchase limit:
a) Not to exceed $2,000.00 for services subject to the Davis-Bacon Act.
Not to exceed $250,000.00
b) Not to exceed $2,500.00 for services subject to the Service Contract Act.
c) Not to exceed $10,000.00 for supplies and services.
2. Contracting Officers:
Not to exceed $250,000.00
Not to exceed $999,999.00
3. Pegasys Default Coding:
Obtain the code from your program office.
Section IV - Approving Official
1. Complete the fields, sign, and date.
Section V - Accounting Transaction Reconciler
1. Complete only if you select Section 1D (Reconciler Changes).
Section VI - Signatures
1. Requesting Official:
Signature is required for Section I - Type of Action except cancellation of an account. An e-mail is acceptable to cancel an
account (Approving Official should not sign as Requesting Official).
2. Funds Manager:
Signature is required for Section 1A, 1E.1, and 1E.4
GSA 3661 (REV. 3/2018) BACK
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