36C77619R0003-027.doc

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HIG19-1 Healthcare Identity Management Support (HC IdM)
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36C77619R0003
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36C77619R0003 S02 - ATTACHMENT 28 - CONTRACTOR PERSONNEL CHANGE FORM.doc

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Text version

Contractor Personnel Change Form

Contractor/Vendor:
Purchase Order # /Contract #:
Project:
Vendor POC:
Vendor POC Phone No:
Date Submitted:
Personnel to be Added
New Personnel Work Address and Phone Number (If working remote, state remote address and telephone number).
Personnel to be Replaced
Proposed Effective Date
Project Role
Labor Category
Hourly Labor Rate
Hour Cap (amount)
Resume Meets Qualifications?

Reason:

Comments/Special Instructions:

The contractor is responsible for updating the background investigation template as personnel are added to the order. The contractor must submit the updated template to the contracting officer within five business days after the added personnel are approved by the PM and COTR. The background investigation forms and fingerprinting must be completed within five (5) business days of the personnel being added to the order.

File details come from the government source that posted it.