TN 30 (03-02)
DI 39506.251 Preparation Instructions for Form SSA-871
A. Procedure - form heading
Enter official name of the agency, State, fiscal year, and reporting period in the designated space.
B. Procedure - report columns
1. Column (a) – Description of Equipment
Enter description of equipment under appropriate category for which disbursements have been made during the quarter being reported.
2. Column (b) – Type of Approval
The purchase of all EDP equipment/upgrades falls within three types of authority (see below). For each item listed under New EDP Equipment/Upgrades, enter the type of authority approved for the purchase:
Enter “C” if the item was approved under SSA Central Office (CO) authority
Enter “R” if the item was approved under SSA regional office (RO) authority
Enter “D” if the item was purchased under DDS line item authority
Leave this column blank for non-EDP equipment.
a. Central Office (CO) authority
Generally, Central Office authority is for large EDP purchases (e.g., legacy processor upgrades, etc.). DDS requests/proposals must meet the following criteria when submitting under CO authority/approval:
Must be for critical operational needs,
Must meet SSA standards or specifications for equipment (hardware and software) and/or services where appropriate, and
Must show savings (in terms of resources, case processing, etc.)
b. Regional Office (RO) authority
Each regional office has authority to approve EDP purchases up to $10,000 per DDS request. Approval is contingent on whether the requests meet the criteria for a critical or emergency need and must be within existing DDS operating funds.
c. DDS authority
Each DDS has $10,000 annual authority to purchase EDP related equipment. The criteria for this DDS authority follows:
The purchase must be within existing operating funds and cannot have any fiscal impact on the state's ability to process their budgeted workload.
The DDS must inform SSA regional office--with a description and cost of purchase--to obtain a line item.
3. Column (c) – Date of Approval
Enter the date funding was approved for each item listed under CO and RO authority. Enter date of purchase for each item listed under DDS authority.
4. Column (d) and (e) – Number of Units (Additional/Replacement)
List the number of units in the appropriate column, (d) additional or (e) replacement.
5. Column (f) -- Unit Cost
Enter the unit cost for each item listed in column (a). The unit cost should include taxes, delivery, and installation costs.
6. Column (g) -- Gross Cost
This column should reflect the gross cost for each item listed in column (a)--derived by multiplying the number of items in column (d) or (e) by the unit cost, column (f).
7. Column (h) – Trade-in Value, If Replacement Item
Enter the expected value of items being traded with purchase of units shown in column (e).
8. Column (i) -- Net Cost *
This column should reflect the Net Cost of each item listed in column (a)—derived by subtracting the trade-in value (amount shown in column h) from the gross cost (amount shown in column g).
C. Procedure - line item reporting
1. New EDP equipment/upgrades
Enter description of the new EDP equipment/upgrade for which disbursements have been made during the quarter being reported. (See also DI 39506.210D.4.d.)
Enter description of other equipment (excluding EDP equipment/upgrades) for which disbursements have been made during the quarter being reported. (See also DI 39506.210D.4.e.)
D. Procedure - total net cost of equipment
This line should reflect the total Net Cost of equipment listed in column (a)--derived by adding the amounts shown in column (i).
E. Procedure - signature/date
Sign and date Form SSA-871.