36C10E21Q0009_1.docx

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1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

VA

N/A 36C10E21Q0009 11-17-2020 Rebecca S. Quilhot 563-424-5874 12-17-2020

3:00 PM

CST

00101 Department of Veterans Affairs Veterans Benefits Administration Acquisition Division 1800 G. Street N.W.

Washington DC 20006 X X 624310 $11 Million N/A X 00326 Department of Veterans Affairs Veterans Benefits Administration Veterans Readiness and Employment 575 North Pennsylvania Street Indianapolis IN 46204 00101 Department of Veterans Affairs Veterans Benefits Administration Acquisition Division 1800 G. Street N.W.

Washington DC 20006

All invoices must be submitted via the VA's Centralized Admin Accounting Transaction Systems (CAATS) - See Attachment H

See CONTINUATION Page The Contractor shall provide Veterans Readiness Rehab-ilitation and Employment Chapter 31 Services - Discrete Services - Independent Living (IL) Assessment and Life Skills Coaching to eligible veterans pursuant to the terms and conditions contained herein. (Indianapolis VA Regional Office - entire jurisdiction)

FINAL DATE

for questions will be Monday December 7, 2020 at 3:00PM Central Standard Time to: rebecca.quilhot@va.gov. All questions/answers will be posted as amendments on Contract Opportunities.

Date and time set for all proposals is Thursday December 17, 2020 at 3:00 PM Central Standard Time.

Quotes received in response to this solicitation will only be considered for award if the offeror is a Service-Disabled Veteran-Owned Small Business concern that is verified by the Center for Verification Excellence (CVE) VIP database at https://www.vip.vetbiz.va.gov at (1) the date and time set for receipt of quotes; and (2) at the time of award. Any quote submitted by offerors who are not verified as set-forth above will be rejected and considered(non-responsive).

See CONTINUATION Page

TO BE CITED ON INDIVIDUAL TASK ORDERS

X X X 1(One) Rebecca S. Quilhot

VA-VBA-2020-144ED0C2

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C10E Rebecca S. Quilhot

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

All invoices must be submitted via the VA's Centralized Admin Accounting Transaction Systems (CAATS) – See Attachment H

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

B.2 PERFORMANCE WORK STATEMENT

Indianapolis Regional Office VR&E Indianapolis DISCRETE SERVICES SECTION I - INTRODUCTION and BACKGROUND

A. INTRODUCTION

1. The Department of Veterans Affairs (VA) has authority, pursuant to Title 38 USC Chapters 18, 31, 35 and 36, to provide all services and assistance necessary to enable eligible Veterans with service-connected disabilities to obtain and maintain suitable employment and, if not employable, achieve independence in daily living to the maximum extent feasible. In the discharge of this responsibility, the Veterans Readiness and Employment Service Division (VR&E) within each VBA Regional Office’s (RO) jurisdiction undertakes an initial evaluation of the Veteran to determine his or her entitlement for these services and assistance and develops, in cooperation with the Veteran, an Individualized Written Plan of Services. Rehabilitation plans include: Individualized Written Rehabilitation Plans (IWRP) that outline training and job placement services needed to achieve employment goals; employment placement under an Individualized Employment Assistance Plan (IEAP); Individualized Extended Evaluation Plan (IEEP) to determine feasibility for employment; or if employment is not possible, services to enhance the Veteran’s independence in daily living under an Individualized Independent Living Plan (IILP).

2. The Veterans Benefits Administration (VBA), Department of Veterans Affairs (VA) is charged with providing assistance to Veterans with service-connected disabilities through Veterans Readiness and Employment (VR&E) services. In order to assure services in close geographic proximity to Veterans and to provide timely services when staff turnover occurs, Contractor assistance may be required to supplement VR&E services. Specialized services may also be required to complement services typically provided by VA Staff.

3. In order to provide these services, VR&E requires Contractor assistance in discrete services to provide for the specialized needs of Veterans.

4. The objective of the contract is to assist Veterans to obtain and maintain suitable employment and to live as independently as possible in their homes and communities.

B. BACKGROUND

1. Department of Veterans Affairs, Veterans Benefits Administration (VBA), is procuring local services for Veterans through VA’s jurisdiction Under the terms of any contract awarded as a result of this solicitation, an authorized VR&E official will be responsible for: (1) Approval of rehabilitation plans and; (2) Approval or authorization of any specific expenditure or benefit to, or on behalf of, the Veteran whose case is referred to the Contractor. It is understood that no obligation will be incurred under the contract by the Government for any services or benefit to, or on behalf of, a Veteran without prior authorization issued by the designated VR&E official.

SECTION II – SCOPE and APPLICABLE DOCUMENTS

A. SCOPE

1. The VA has a requirement for Contractors to provide services for Discrete Services

2. Services to be performed under the terms and conditions of the Contract are restricted to the major rehabilitation track for those Veterans whose primary rehabilitative objectives include: (1) achievement of independence in daily living.

3. Rehabilitation Objectives:

a. The rehabilitation objective for a Veteran for whom the achievement of a vocational goal has been determined to be infeasible is: (1) to enable the Veteran to achieve independence in daily living; or (2) to reduce the level of assistance required from others. The Contractor, in the case of an individual found by the VA to qualify for a program of independent living service, shall assess and recommend all services and assistance necessary to enable the Veteran to achieve maximum independence in daily living.

4. Discrete Services include the following five categories

a. Independent Living Assessments- In-home assessment of an individual’s ability to care for themselves daily and live independently at home and in the community.

b. Life Skills Coaching- Hourly services to individuals in need of one-on- one life skills coaching to develop and sustain independence in the community, for example; utilizing public transportation, establishing and maintaining volunteer work, budgeting, etc.

B. APPLICABLE DOCUMENTS

The following references are applicable to this PWS:

1. Chapters 18, 31, 35 and 36 of Title 38, United States Code www.va.gov/

1. M28, Veterans Readiness and Employment Manual (http://www.warms.vba.va.gov)

1. Commission on Rehabilitation Counselor Certification (http://www.crccertification.com)

1. 38 CFR 21.283 (http://edocket.access.gpo.gov/cfr_2004/julqtr/pdf/38cfr21.284.pdf)

C. BACKGROUND INVESTIGATION

The contract employee level of background investigation and clearance required for this effort is NACI. Work may not commence until the appropriate background investigation has commenced.

1. CONTRACTOR RESPONSIBILITIES

a) The Contractor shall bear the expense of obtaining background investigations. The cost of background investigations is based on the current Office of Personnel Management (OPM) rate at the time the application is processed at OPM. Fiscal Year 2017 rates are as follows: Low Risk (NACI) $381, Moderate Risk (MBI) $1,730, High Risk (BI) $4431 or Reciprocals are $62. VA will pay for investigations processed through the VA SIC and conducted by the Office of Personnel Management (OPM) in advance; however, the Contractor shall reimburse the full cost of background investigations to VA within 30 days of Bill of Collections from VA. VA shall send up to three plus one final delinquent notice to the Contractor. If the Contractor does not adhere to the Bill of Collections, future invoices may be subject to be offset by VA to recoup background investigation costs.

b) Immediately after contract or task order award, the Contractor must submit a completed Attachment C form (VBA Contractor Background Investigation Request Worksheet) for all contract employees working the contract, who have access to VA facilities, VA systems, or privacy data, to the COR.

c) The Contractor and Contractor point of contact (POC) will receive an email notification from SIC identifying the website link that includes detailed instructions regarding completion of the background clearance application process and what level of background was requested. Reminder notifications will be sent if the complete package is not submitted by the due date.

d) The Contractor shall prescreen all personnel who require access to VA site(s) and/or access to VA LAN systems to ensure they maintain a U.S. citizenship or Alien Registration that authorizes them to work in the U.S. and are able to read, write, speak, and understand the English language.

e) Contractors who have current favorable background investigation conducted by OPM or Defense Security Service (DSS) may be accepted through reciprocation. However, it does not preclude the Contractor from submitting a completed Attachment C form immediately after contract or task order award for all contract employees working the contract to the COR.

f) Contract performance shall not commence before SIC confirmation that it received the investigative documents, that they are complete, and that the background investigation has begun. Once the Contractor’s background investigation has been initiated, contract performance may commence. The COR will notify and forward the Contractor a copy of the Certificate of Eligibility (form 4236) to the Contractor when the investigation has been favorably completed and adjudicated. The Contractor, if notified of an unfavorable adjudication by the Government, shall withdraw the employee from consideration from working under the contract. Failure to comply with the Contractor personnel security requirements may result in termination of the contract for default.

g) If the security clearance investigation is not completed prior to the start date of the contract, the contract employee may work on the contract with an initiated status while the security clearance is being processed. However, the Contractor will be responsible for the actions of those contract and subcontract employees they provide to perform work for VA. In the event damage arises from work performed by Contractor personnel, under the auspices of the contract, the Contractor will be responsible for resources necessary to remedy the incident.

h) Should the Contractor use a vendor other than OPM or DSS to conduct investigations, the investigative company must be certified by OPM/DSS to conduct Contractor investigations. The Vendor Cage Code number must be provided to the VA SIC, which will verify the information and conclude whether access to the Government’s site(s) and/or VA LAN systems can be.

i) The investigative history for Contractor personnel working under this contract must be maintained in the databases of either OPM or the Defense Industrial Security Clearance Organization (DISCO).

2. GOVERNMENT RESPONSIBILITIES

a) After the COR has received Attachment C form(s) from the Contractor, SIC will send an e-mail notification to the Contractor and their POC identifying the website link that includes detailed instructions regarding completion of the background clearance application process and what level of background was requested. SIC will also send reminder notifications to the Contractor and their POC if the complete package is not submitted by the due date.

b) Upon receipt of required investigative documents, SIC will review the investigative documents for completion and initiate the background investigation by forwarding the investigative documents to OPM to conduct the background investigation. If the investigative documents are not complete, SIC will return the package to the Contractor with corrective instructions.

c) VA will pay for investigations processed through the VA SIC and conducted by OPM in advance; however, the Contractor shall reimburse the full cost of background investigations to VA within 30 days of Bill of Collections from VA. VA shall send up to three plus one final delinquent notice to the Contractor. If the Contractor does not adhere to the Bill of Collections, future invoices may be subject to be offset by VA to recoup background investigation costs and may be considered grounds for default.

d) The COR will notify and forward the Contractor a copy of the Certificate of Eligibility (form 4236) when the investigation has been favorably completed and adjudicated. The COR will also notify the Contractor of an unfavorable adjudication by the Government.

D. CONFIDENTIALITY AND NONDISCLOSURE

It is agreed that:

1. The preliminary and final deliverables and all associated working papers, application source code, and other material deemed relevant by the VA which have been generated by the contractor in the performance of this task order are the exclusive property of the U.S. Government, and shall be submitted to the COR at the conclusion of the task order.

2. The CO will be the sole authorized official to release verbally or in writing, any data, the draft deliverables, the final deliverables, or any other written or printed materials pertaining to this task order. No information shall be released by the contractor. Any request for information relating to this task order presented to the contractor shall be submitted to the CO for response.

3. Press releases, marketing material or any other printed or electronic documentation related to this project, shall not be publicized without the written approval of the CO.

SECTION III – PERFORMANCE REQUIREMENTS

PERFORMANCE REQUIREMENTS

PERFORMANCE REQUIREMENTS: Discrete Services – VR&E Indianapolis will provide case-related documents as needed from the Counseling Evaluation Rehabilitation (CER) file to the Contractor.

The following services shall be provided as directed to the Contractor for Service members and Veterans participating in the VR&E program:

DISCRETE SERVICES

This includes independent living (IL) assessments. Contractor personnel may need to travel to remote locations. Due to the scope of these individualized services, VA may authorize travel expenses. In all cases, pre-approval of travel costs is required by the VA.

Discrete services include short-term, unique services needed for Veterans during the rehabilitation process. The following Discrete Services may be ordered on an as needed basis:

a. Independent Living Assessment: This flat-rate package is for an in-home assessment of an individual's ability to care for themselves on a daily basis and live independently at home and in the community. The initial appointment will take place within 10 calendar days of referral and the final report will be submitted within 30 calendar days of referral. The report will correspond with requirements in M28. The average number of hours to complete an Independent Living assessment is four (4) hours.

a. For the Independent Living Assessments, a locally licensed Occupational Therapist (OT) or Certified Rehabilitation Counselor will be required. Other services that may be required under Discrete Services must be provided by contract service providers that have the experience and training to complete the tasks assigned to industry standards. See minimum qualifications outlined in Section III C.

b. Reports: Reports for flat rate packages are due within 30 calendar days of referral. Reports for hourly packages are due within seven (7) calendar days of the conclusion of each ten (10) hours of billing or each 30 calendar days post referral, whichever date is earliest. Contractor will utilize mandatory forms and work aids identified in M28 references.

c. Payment: Flat Rate Service Discrete Services package- Independent Living Assessments are payable if complete services are delivered within performance standards. All payments shall be contingent upon meeting the performance standards.

d. Report templates for Discrete Services are generated by the contractor.

b. Life Skills Coaching: This is an hourly service to individuals in need of one-on-one life skills coaching to develop and sustain independence in the community, for example, utilizing public transportation, establishing and maintaining volunteer work, etc

a. For Life Skills Coaching, a Certified Rehabilitation Counselor or contract service providers that have the experience and training to complete the tasks assigned to industry standards. See minimum qualifications outlined in Section III C.

b. Reports: Reports for hourly packages are due within seven (7) calendar days of the conclusion of each ten (10) hours of billing or each 30 calendar days post referral, whichever date is earliest. Contractor will utilize mandatory forms and work aids identified in M28 references.

c. Payment: Flat Rate Service Discrete Services package- Independent Living Assessments are payable if complete services are delivered within performance standards. All payments shall be contingent upon meeting the performance standards.

d. Report templates for Discrete Services are generated by the contractor.

c. The C&A requirements do not apply and the Security Accreditation Package is not required.

1) PERFORMANCE REQUIREMENTS SUMMARY (PRS)

Discrete Services

Independent Living Assessment reference

Life Skills Coaching Reports are due within 30 calendar days of referral.

Reports are due within seven (7) calendar days of the conclusion of each ten (10) hours of billing or each 30 calendar days post referral, whichever date is earliest Reports are received timely based on the performance standard 90% of the time.

95% of Veterans receive the appropriate specialized services identified by the VA.

Electronic mail date stamp by the receiving official

COR review of report

a. Coverage of Jurisdiction – Contractor shall have an adequate number of trained counseling staff to ensure provision of services for Veteran clientele throughout the Commonwealth of Indiana.

b. Responsiveness - If awarded a contract, the Contractor shall address problem issues with the Contracting Officer Representative (COR) or Quality Assurance Manager (QAM) in a timely manner to ensure services are rendered and reports are submitted within required timelines identified in the PWS.

c. Customer Satisfaction – The Contractor shall provide a level of service that is responsive to Veteran or eligible dependents’ needs, as evidenced by positive feedback from clients, lack of complaints, and periodic contact of clients by VR&E to assess customer satisfaction.

B. KEY PERSONNEL

1. The key personnel listed below are considered essential by the Government and to the work being performed under the TOs awarded under the contract, and shall not be replaced or substituted for the first 180 days (or other date specified in the TO) after TO award. The key personnel assigned to or utilized by the Contractor in the performance of a TO must be accessible to the Government for services under the contract. Replacements due to circumstances beyond the Contractor's control such as death, illness or the like must be of equal or better qualifications and approved by the COR. The Contractor and/or Key Personnel shall be insured, licensed and/or certified if required by the state or local statute for all ROs proposed. The Contractor shall supply proof of state required insurance, license and/or certification to the RO COR within 30 days after notice of award. The following are the list of Key Personnel:

a. Contract Administrator/Program Manager

b. All counselors (rehabilitation, job placement, and other)

c. Occupational Therapists

d. Assistive Technology Professionals

e. Employment Specialists

2. The Government reserves the right to examine and approve or disapprove the Contractor’s staff based on information provided in credentials and/or résumés. The COR, at the RO will notify the Contractor of acceptance of newly proposed employees within 10 days of receipt of credentials, diplomas, and résumés.

3. Only those individuals that meet the qualifications of the contract, and have been approved by the COR, at the RO shall perform services under the contract and the subsequent TO’s. Under no circumstances will interns be approved to provide professional services under the contract.

C. QUALIFICATION REQUIREMENTS FOR KEY PERSONNEL

1. Contract Administrator/Program Manager:

Contract Administrator/Program Manager must have one (1) year experience in Technical Vocational Rehabilitation and management of rehabilitation services. They must possess communication/office skills commensurate with the job.

2. All Counselors:

Counselors must possess a minimum of a master’s degree in Rehabilitation Counseling, Counseling Psychology, Counselor Education, or a closely related Master’s level counseling discipline, from an accredited college or university. Contractor shall maintain curriculum vitae, résumé, current licenses, certification or a verifiable form of documentation for each Counselor proposed under the contract and for any proposed Counselor during the life of the contract. Related counseling disciplines will be considered from accredited colleges or universities when the individual has completed coursework that includes medical aspects of disability, vocational testing, and job placement and/or possesses a Commission on Rehabilitation Counselor Certification (CRC) or Certified Vocational Evaluator credential, and/or possesses two or more years of experience in the vocational rehabilitation field. Counselors, in the performance of services under the contract, shall use standard counseling principles and procedures generally recognized within the counseling profession by the Commission on Rehabilitation Counselor Certification (CRC) at http://www.crccertification.com.

3. Other professionals:

a. Employment Specialists: Providers must possess at least two years’ experience in providing direct job placement and/or job readiness services. The Contractor shall maintain résumés, current licenses, and/or certifications for Contractor personnel performing Employment Services. Individuals who possess the qualifications outlined for contract counselors above may be approved to provide employment services even if they do not possess required employment services experience.

b. Independent Living (IL) Assessments: Occupational Therapists (OT) or Certified Rehabilitation Counselors shall be certified and licensed if required by local state or statute. The Contractor shall maintain résumés, current licenses, and/or certifications for Contractor personnel performing IL Assessment services.

c. For Rehabilitation Engineering Assessments, a locally licensed Occupational Therapist (OT), Certified Rehabilitation Counselor (CRC), or Assistive Technology Practitioner (ATP) will be required.

d. Discrete Services (Other than IL): Job coaching, life skill coaching and job site analysis shall be no less than a Rehabilitation Counselor (see IV.C.2. above). Contractor shall maintain resumes, current licenses and/or certifications for Contractor personnel performing Discrete Services.

4. The Contractor shall require its professional staff to attend free training sessions given by the VA. Contractors are responsible for the transportation/per diem cost of attendance by the Counselor(s) attending these training sessions at the sponsored VA Regional Office, not to exceed 24 total hours. The Contractor shall be responsible for providing its staff with at least two (2) (equivalent to two (2) or more C.E.U.s) additional relevant professional training courses per year in the field of counseling and rehabilitation. VA or other organizations, such as colleges or professional associations, generally recognized as providing such training, shall sponsor the courses. This training is required for continued performance under the contract by any Contract professional. The Contractor shall report annually to the COR at the RO, the names of courses taken, date of any course, and the provider of said course for each Contract professional proposed to work or working under the contract. Exceptions or alternate training methods may be approved for Contractors located OCONUS.

SECTION IV - SPECIAL REQUIREMENTS

A. PROCEDURES FOR ABOVE STANDARD AND BELOW STANDARD PERFORMANCE

1) Above standard performance. This contract does not provide monetary incentive above the value of the task order for performance above standard. This circumstance does not however lessen the importance of timely and quality performance of all tasks under this contract. The COR and others performing surveillance will document high quality performance (e.g., timely delivery of data, accurate and quality content of reports) and ensure this record of performance becomes part of the Contractor’s past performance record which will be entered annually in Past Performance Information Retrieval System (PPIRS). PPIRS is used by federal contract agencies to evaluate Contractor past performance.

2) Below standard performance. All reports that are not prepared in accordance with M28 manual and will be returned to the Contractor for correction at the Contractor’s expense. The Contractor cannot invoice or receive payment until a report has been determined acceptable by the applicable COR in writing on the QA Form. The COR and others performing surveillance will document below standard performance (i.e., untimely submission of reports, report submissions requiring multiple revisions, consistently falling below Acceptable Quality Level (AQL(s)) and ensure this record of performance becomes part of the Contractor’s past performance record. The Contractor’s past performance record will be considered in placement of future task orders (if applicable) and be entered into PPIRS.

SECTION V – Attachments for Discrete Services

INDEPENDENT LIVING ASSESSMENT

Independent Living Assessment: This flat-rate package is for an in-home assessment of an individual's ability to care for themselves on a daily basis and live independently at home and in the community. The initial appointment will take place within 10 calendar days of referral and the final report will be submitted within 30 days of referral. The report will correspond with requirements in M28. The average number of hours to complete an Independent Living assessment is four (4) hours.

Suggested Narrative Format (may include, but not limited to)

Contractor company name/address/phone:

Referral Source:

Veteran Name:

VA File (Last 4):

Name of Evaluator:

Date of Assessment:

Potential IL Goal:

Location of Assessment:

(Overview) The philosophical framework provides the principles that direct the scope and practice for developing independent living (IL) plans. The philosophical framework is composed of the following nine principles.

· Enhance participation in activities of daily living (ADL)

· Assist the Veteran in participating to the maximum extent possible and desirable in family and community life

· Provide the most effective services and assistive technology based on sound research evidence

· Provide required holistic evaluation and services for all Veterans who qualify

· Develop rehabilitation plans that provide services to address identified independent living needs

· Consider the Veteran’s expressed interests and desires, but provide services based on objectively identified needs

· Establish goals and measure/verify outcomes

· Provide services that produce a sustaining influence that continues after rehabilitation services are completed, and

· Explore the possibility of paid or volunteer employment, when feasible.

The Independent Living (IL) assessment is intended to obtain a general overview of a Veteran’s independent living situation. It is designed to review arrangements that may complement or cause potential barriers to living independently, and once these issues are addressed, where feasible, increase the potentiality of obtaining or maintaining employment. Answer each question with a narrative description to include strengths, weaknesses, and issues. Yes/No responses to the questions are not an acceptable assessment. Assessing the Veteran in their current living environment is required unless waived by the VA Counselor.

The following questions and descriptions are meant to be an example of the type of information that should be assessed. The assessment narrative must address all pertinent observations from the assessment.

Mobility – refers to the capability of moving efficiently from place to place Can the Veteran move safely around their home and community?

· Is there safe ingress and egress in the Veteran’s home?

· Are there barriers to mobility within the Veteran’s home?

· What distance is the Veteran capable of walking in varied weather conditions?

· Are there any physical barriers and/or disability ramifications that impact the Veteran’s ability to independently move from place to place?

· What mobility aids does the Veteran currently use or may be needed?

· Is the Veteran willing to use the above?

Does the Veteran have means for transportation in order to meet their needs?

· Does the Veteran live close to or have access to public transportation?

· Are there any restrictions to the public transportation for the Veteran, i.e. para-transit eligibility, etc.?

· Does the Veteran have friends, family or support services to provide reliable transportation when needed?

Communication – refers to accurate and efficient transmission and/or reception of information, either verbally (spoken or written) or non-verbally.

Does the Veteran have access to a telephone?

· Does the Veteran have appropriate phone numbers to use in case of an emergency?

· Does the Veteran know how to use the telephone?

· Are there any disability ramifications that make use of a telephone difficult or impossible?

Does the Veteran's housing situation facilitate or interfere with improved independence?

· The housing situation such as owning, renting, subsidized, house, or apartment, and the physical layout of the home?

· If the Veteran is receiving subsidized housing, are they complying with the requirements?

· Are there other people living with the Veteran such as a spouse, children, grandchildren, or roommates?

· Do other members of the Veteran’s household contribute to or diminish the Veteran’s independence?

· Could other people who are not living with the Veteran cause potential problems as the Veteran works to improve their independence?

· Are there environmental factors in the Veteran’s housing situation that are detrimental (noisy area, unsafe area, etc.)?

Does the Veteran have children? If yes, are daycare and backup daycare arrangements available?

· Does the Veteran have children or other dependents in the family unit they take responsibility for?

· Is there someone else at the home to provide daycare services? If yes, are they reliable?

· Does the Veteran have a daycare provider? If yes, are they reliable?

· Does the Veteran have a backup daycare provider?

· Does the Veteran have a plan for the children in the event of a medical emergency?

Self Care – refers to the skills necessary to fulfill basic needs such as they relate to health, safety, food preparation and nutrition, hygiene and grooming, and money management.

Does the Veteran have the means and ability to adequately and appropriately meet their nutritional needs?

· Can the Veteran safely and independently prepare meals and snacks?

· If not, does the Veteran have someone who can assist them?

· Does the Veteran (or the Veteran’s meal preparer/provider) understand and adhere to any special dietary considerations the Veteran may have?

· Can the Veteran shop independently or are other arrangements in place to ensure that food is available?

· Does the Veteran appropriately store food and recognize spoiled food so that they do not get sick?

· Do financial considerations interfere with the Veteran’s ability to maintain a healthy diet?

Does the Veteran need help or training in other areas to improve their independence?

· Does the Veteran demonstrate appropriate hygiene patterns?

· Does the Veteran remember to take their medication on a regular basis?

· Does the Veteran dress appropriately?

· Is the Veteran’s disability so severe that they need someone to provide them with daily assistance in getting ready in the morning and/or during the day? Describe.

Does the Veteran have the ability to budget their finances?

· Does the Veteran maintain a checking account?

· Does the Veteran have a history of balancing their budget and managing their income?

· Does the Veteran have enough income to meet basic needs?

· Is the Veteran receiving all appropriate VA and non-VA benefits (SSDI, SSI, VA disability, Worker’s Compensation, etc.)?

· Is the Veteran competent to handle VA funds?

· Does the Veteran provide support for other family or non-family members?

· Does the Veteran have support services to help them maintain their budget?

Self-Direction – describes the capacity to organize structure and manage activities in a manner that best serves the objectives of the Veteran. Adequate self-direction requires that a Veteran be able to plan, initiate and monitor behavior with respect to an identified outcome.

Does the Veteran have the means to adequately manage their income?

· Can or does the Veteran do direct deposit with their paycheck?

· How much are the Veteran’s monthly living expenses?

· Is the Veteran keeping up with their bills?

· Does the Veteran have any major outstanding bills?

· Has the Veteran over extended their credit cards?

· Does the Veteran have any legal issues pending due to financial circumstances?

· Are there any outstanding judgments against the Veteran?

· Does the Veteran understand if they have SSI or SSDI, when they get their payment and how much it will be?

· Is the Veteran capable of reporting their wages to SSA?

· Does the Veteran have any current issues or overpayment payment problems from SSA?

Does the Veteran have difficulty waking up in the morning?

· Does the Veteran have an alarm clock?

· Does the Veteran have a history of over sleeping and missing appointments?

· Is the Veteran taking any medications that cause problems related to waking up, maintaining alertness, or motivation?

· Does the Veteran feel they are a morning or evening person?

· What time of day does the Veteran usually wake up?

· How long does it take the Veteran to get ready in the morning?

Interpersonal Skills – the ability of the Veteran to interact in a socially acceptable and mature manner with family members, service providers, neighbors, medical providers and others encountered in routine interactions in the community.

Does the Veteran tend to consume alcohol and/or use illegal substances?

· Has the Veteran ever experienced issues with addiction or overuse of alcohol?

· Are the above currently issues in the Veteran’s life? If so, does the Veteran participate in therapy or a sobriety support program?

· Does the Veteran have any anger management issues or other patterns of inappropriate interpersonal behavior that interfere with forming or maintaining healthy relationships?

Are there any cultural, religious or extended family considerations?

· Does the Veteran have any cultural, religious or extended family that might impose on the Veteran's current living situation? This could include issues with childcare arrangements, brothers, sisters or parents.

· Are there any issues related to the people named above that could cause issues for the Veteran?

· Does the Veteran attend cultural or religious events on a regular basis?

· Do cultural, religious, or extended family considerations impact the Veteran’s ability to appropriately interact with other individuals or groups?

Productive Activities - the ability to perform activities which contribute to family and/or the community, through the performance of tasks that produce goods and services, whether paid or not.

· Does the Veteran have adequate time management skills to complete all tasks related to engagement in an appropriate productive activity?

· Does the Veteran have any hobbies or participate in any recreational activities?

· How much time does the Veteran spend in these activities per day/week/month?

· Does the Veteran interact with others while performing or participating in these activities?

· Does the Veteran have regular sports or social events that they participate in?

Future Goals – what the Veteran hopes or envisions for their life in the short and/or long term

· What does the Veteran express as their highest priority?

· Where is employment in their list of priorities?

· Is it the Veteran’s goal to live more independently?

· What does “living more independently” specifically mean for this Veteran?

Specify potential goals and how those may be achieved, including resources needed and timeframes

LIFE SKILLS COACHING

The Contractor shall provide these services to individuals in need of one-on-one life skills coaching to develop and sustain independence in the community, for example, utilizing public transportation, establishing and maintaining volunteer work, etc. No more than ten hours of services will be referred at a time.

B.3 PRICE/COST SCHEDULE

ITEM INFORMATION

QUANTITY

Discrete Services - Independent Living Assessments Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 624310 - Vocational Rehabilitation Services PRODUCT/SERVICE CODE: G004 - Social - Social Rehabilitation

Discrete Services - Life Skills Coaching Contract Period: Base POP Begin:

POP End:

Discrete Services - Independent Living Assessments Contract Period: Option 1 POP Begin:

POP End:

Discrete Services - Life Skills Coaching Contract Period: Option 1 POP Begin:

POP End:

Discrete Services - Independent Living Assessments Contract Period: Option 2 POP Begin:

POP End:

Discrete Services - Life Skills Coaching Contract Period: Option 2 POP Begin:

POP End:

Discrete Services - Independent Living Assessments Contract Period: Option 3 POP Begin:

POP End:

Discrete Services - Life Skills Coaching Contract Period: Option 3 POP Begin:

POP End:

B.4 DELIVERY SCHEDULE

Veterans Readiness and Employment Div(28) 575 North Pennsylvania Street Indianapolis, IN 46204 0.00

Veterans Readiness and Employment Div(28) 575 North Pennsylvania Street

0.00

Veterans Readiness and Employment Div(28) 575 North Pennsylvania Street

0.00

Veterans Readiness and Employment Div(28) 575 North Pennsylvania Street

0.00

Veterans Readiness and Employment Div(28) 575 North Pennsylvania Street

0.00

Veterans Readiness and Employment Div(28) 575 North Pennsylvania Street

0.00

Veterans Readiness and Employment Div(28) 575 North Pennsylvania Street

0.00

Veterans Readiness and Employment Div(28) 575 North Pennsylvania Street

0.00

36C10E21Q0009

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SECTION C - CONTRACT CLAUSES

C.1 IT CONTRACT SECURITY

VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY

1. GENERAL

Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

2. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS

a. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.

b. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.

c. Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.

d. Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor.

e. The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor's employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.

3. VA INFORMATION CUSTODIAL LANGUAGE

a. Information made available to the contractor or subcontractor by VA for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the VA. This clause expressly limits the contractor/subcontractor's rights to use data as described in Rights in Data - General, FAR 52.227-14(d) (1).

b. VA information should not be co-mingled, if possible, with any other data on the contractors/subcontractor's information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met. If co-mingling must be allowed to meet the requirements of the business need, the contractor must ensure that VA's information is returned to the VA or destroyed in accordance with VA's sanitization requirements. VA reserves the right to conduct on site inspections of contractor and subcontractor IT resources to ensure data security controls, separation of data and job duties, and destruction/media sanitization procedures are in compliance with VA directive requirements.

c. Prior to termination or completion of this contract, contractor/ subcontractor must not destroy information received from VA, or gathered/ created by the contractor in the course of performing this contract without prior written approval by the VA. Any data destruction done on behalf of VA by a contractor/subcontractor must be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management and its Handbook 6300.1 Records Management Procedures, applicable VA Records Control Schedules, and VA Handbook 6500.1, Electronic Media Sanitization.