17-Attachment 02-OE Application Submission Checklist.pdf
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- Solicitation number
- 3202600155
- Issued by
- Texas
About this file
This is an Application Submission Checklist for the Texas Workforce Commission-Vocational Rehabilitation (TWC-VR) division's Open Enrollment solicitation for Orientation and Mobility Services. The checklist is designed to assist applicants in preparing responsive applications for the provision of Orientation and Mobility Services to VR customers across all TWC-VR Workforce Solutions offices throughout Texas. The checklist itself is not a mandatory submission requirement; however, applicants are responsible for reviewing all application requirements and ensuring submission of all necessary materials to constitute a complete application.
The checklist identifies twelve required forms and supporting documentation that applicants must submit as part of their application package. These forms include standard certifications and organizational information such as the Execution of Application, W-9 and Direct Deposit Form, Child Support Certification, TWC VR Standards for Provider Certification, Conflict of Interest Certification, Provider Insurance Certification, and Entity Headquarters Information forms covering management, services, and locations. Additionally, applicants must submit Entity Physical Location information and Provider Staff Information forms with supporting documentation. No specific pricing terms, set-asides, funding amounts, or contract duration are detailed in this checklist document.
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ATTACHMENT 2 - OE APPLICATION SUBMISSION
CHECKLIST
This Application Submission Checklist is provided to assist an Applicant in preparing a responsive Application. The checklist is not a requirement and does not need to be attached to the Application. Applicant is responsible for reviewing all Application requirements and ensuring it submits all materials for a complete Application.
□ Form 1 – Execution of Application
□ Form 2 – W-9 and Direct Deposit Form (VR 1020)
□ Form 3 - Child Support Certification (VR 1305)
□ Form 4 – TWC VR Standards for Provider Certification (VR 3443)
□ Form 5 – Conflict of Interest Certification (VR 3444)
□ Form 6 – Provider Insurance Certification (VR 3445)
□ Form 7 – Entity Headquarters Information Management Form
(VR 3441A)
□ Form 8 – Entity Headquarter Information – Services (VR 3441B)
□ Form 9 – Entity Headquarters Information – Location(s) (VR 3441C)
□ Form 10 – Entity’s Physical Location(s) – Part A – Service Contracts Certification (VR 3442A)
□ Form 11 – Entity’s Physical Location(s) – Part B – General Information Service Contracts (VR 3442B)
□ Form 12 – Provider Staff Information Form(s) with Supporting Documentation (VR 3455)
Attachment 2 - oe APPLICATION Submission Checklist
File details come from the government source that posted it. Updated .