3-Attachment 02-OE Application Submission Checklist.pdf
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- Solicitation number
- 3202600157
- Issued by
- Texas
About this file
This is an application submission checklist document associated with an Open Enrollment solicitation issued by the Texas Workforce Commission-Vocational Rehabilitation (TWC-VR) division for Independent Living Services for Older Individuals who are Blind (ILS-OIB). The checklist is designed to assist applicants in preparing responsive applications and identifies twelve required forms and supporting documentation that must be submitted. Services are to be provided to VR customers across all TWC-VR Workforce Solutions offices throughout Texas. The checklist serves as a reference tool to ensure applicant completeness; however, submission of the checklist itself is not required as part of the application package.
The required application documents include execution of application, W-9 and direct deposit forms, child support and conflict of interest certifications, provider insurance verification, entity headquarters information in multiple formats (management structure, services, and locations), physical location certifications and general information for service contracts, and provider staff information with supporting documentation. All applicants must meet specified requirements and qualifications outlined in the solicitation to be eligible to provide services under this open enrollment opportunity. The checklist clarifies that applicant responsibility extends to reviewing all application requirements independently and ensuring submission of all materials necessary for a complete and responsive application.
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Text version
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 Verification (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 .