ATTACHMENT F thru M Updated.pdf

ATTACHMENT F – TECH REFRESH

IDENTIFICATION OF TESTING SAMPLES AND CHECKLIST OF ITEMS TO SUBMIT

Instructions: Identify the technology refresh evaluation samples and complete the necessary information as indicated below. Samples should only be submitted for new Group 1, Group 2, or Group 3 devices that the contractor is formally requesting be added to the contract. One sample of the model shall be submitted. In the space provided, please indicate the sample number, group, category, make, model, and serial number of the device being submitted. Also indicate if the battery is rechargeable or non-rechargeable (and indicate size if non-rechargeable). Hearing aids submitted with rechargeable batteries must include all accessories required for charging the sample.

If more than five new models need to be tested, please continue to follow the sample naming convention below, making sure to provide all the requested information.

Please note that BTE hearing aid samples shall be submitted configured with ear hook attached, and RIC hearing aid samples shall be submitted configured with receiver and appropriate dome attached. Also submit the ASNI/ASA S3.22-2014 (R2020) specification sheet for the hearing aid model of each sample.

Check that all required items and information have been included with the samples.

HEARING AID SAMPLES – THD AND EIN TESTS

Sample # TE1– Group: _____ Category:________ Make: _______________ Model: ________________ Serial Number: _______________ Battery (Rechargeable/Non-rechargeable, include size if non-rechargeable):_______________

Sample # TE2– Group: _____ Category:________ Make: _______________ Model: ________________ Serial Number: _______________ Battery (Rechargeable/Non-rechargeable, include size if non-rechargeable):_______________

Sample # TE3 – Group: _____ Category:________

Sample # TE4 – Group: _____ Category:________

Sample # TE5 – Group: _____ Category:________

ATTACHMENT G: BATTERY / EARHOOK INFORMATION

(Sample – Contract Document Attached)

Instructions: For each device submitted, indicate the battery size, average battery drain at reference test (if applicable), battery replacement by end user or only contractor, and earhook type (if applicable). If the device uses more than one battery size, list each separately. Earhook type is specific to standard earhooks issued with the model. Filter designation or retainer earhook would be listed, if applicable.

MODEL NAME BATTERY

SIZE

BATTERY

DRAIN

BATTERY

REPLACEMENT

EARHOOK

TYPE (if applicable)

Styletto 7AX

N/A N/A N/A N/A

CROS Styletto AX

N/A N/A N/A N/A

ATTACHMENT H: MSI FILE FORMAT GUIDELINES FOR PACKAGING

REQUIREMENTS

VA procedures are being established to automate deployment of programming software to the greatest extent possible. This automation will be accomplished using the Microsoft Configuration Manager (CM) architecture or any more recent software deployment methods.

For compatibility with the current VA deployment methodology, vendors should submit software according to the following requirements:

1. The application must not require or involve manual effort to complete the installation on the target environment. If the application does not install silently, it will not be packaged or deployed to workstations with the audiology baseline.

2. Supplemental information such as command-line switches must be provided with the installation instructions, if applicable. If technical information regarding installation is accessible on a manufacturer’s website, a link to the specific web page must be provided.

Do not provide a general website link. Detailed technical information about installation options is required for use by the VA packaging team.

3. In test scenarios, the vendor must explain whether installation is validated in Windows Control Panel - Apps & Features or by the end user launching the application.

4. The MSI file provided from the vendor should not provide any errors from any of the following: Windows Installer Service, the Operating System, or the application itself.

5. The application must be capable of returning a status code of ‘zero’ (0) when installation is completed successfully.

6. The application should NOT install to the root of the C: drive. Rather it should install to C:\Program Files (x86)’ or ‘C:\Program Files’

7. When uninstalled the application should cleanup all remnants (e.g., removing all files, registry entries, and entry into Apps & Features).

8. Desktop icons should be deleted or replaced with the new version, and software should only display in the local Noah instance.

9. The application should support IPv6 Internet Protocol standard per VA requirements.

10. Application versioning should be the same for .msi installer and how it displays in Noah, and the way it’s referenced in any supporting configuration files.

11. Reboots-The Windows installer should NOT invoke any reboot of the operating system which cannot be suppressed. Reboots will be handled through the distribution mechanism.

12. Repair-The application package should be able to repair itself without causing damage to existing applications or the operating system.

13. Uninstall-The application should uninstall the application cleanly without causing damage to the existing applications or the operating system. The only exception is the runtime created resources such as File, registries, or shortcuts).

14. Any applications that require more than one command line to install shall be packaged with a script that performs proper error handling; returning an exit code of 0 only when the application has been completely and successfully installed. Compiled executables as installation methods are NOT supported.

15. Do not bundle applications into wrapper packages, VA requires the applications be provided individually. Any driver installs need to be signed with a valid certificate that the VA recognizes 4and install silently and unattended.

ATTACHMENT I: HEARING AIDS AND WIRELESS DEVICES MODEL NAME

FORMAT

This document must be included with your request to add models to your Hearing Aids and Wireless Systems contract. For each model being added, indicate the group number and the name as you wish it to be on the contract. The name must not exceed 28 spaces, including blank spaces. The name must include the shell type (ie “FS”, “RIC”) For rechargeable hearing aid models (Group 1 – Category 2, Group 2 – Category 2), “-R” must be included at the end of the model name. The name may not include a comma.

EXAMPLE

HEARING AIDS AND WIRELESS DEVICES MODEL NAME FORMAT

Grou p #

MODEL NAME

1 F U L L S H E L L D E V I C E F S

2 B E H I N D T H E E A R D E V I C E B T E

3 R E C H A R G E A B L E R I C - R

BLANK FORM

HEARING AIDS AND WIRELESS DEVICES MODEL NAME FORMAT

Group

MODEL NAME

ATTACHMENT J: Example Data File

EXAMPLE DATA FILE

Below is an example of the text file format for a typical ITE, a wireless system device and a simple remote.

The 13th data element (delineated by “^”) is the indicator of the type of data represented on the remainder of the line. If printed on a color printer or viewed on-line, the hearing aid and circuit data are shown in blue. Lines shown in red contain additional data for the primary features, including the cost of each item after the trial period. Lines shown in bright pink include the name of the available remote controls for the device. Lines shown in dark red include the name of the available chargers for the device. Lines shown in teal are additional fitting formulas that the vendor would like presented in ROES. Lines shown in light blue are the matrices available for the device. Lines shown in green contain secondary features, which have no cost. Incompatibility characters are shown in black and compatibility characters in orange. The “Allow two telecoils” indicator is shown in bright green on the second “INT” line.

This file section indicates that the “MEM/S” is incompatible with the “SWM” directional microphone and also with the “SOFT SEAL COAT” secondary feature. The volume control is recommended (compatible) with the extended receiver tube and the canal lock.

You may assign colors on wireless devices but incompatibility characters do not apply. Use only the following segments for wireless systems: 1, 2, 3, 4, 5, 11, 13, 14, 15 and 16. For simple remotes use segments 1, 2, 3, 4, 5 and 11. For chargers use segments 1,2,3,4,5 and 11.

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^BESTFS2.pdf^^INT^DAI^AUDIO INPUT (AI)^23.18 ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^INT^TCA^TOUCHLESS TELECOIL (TTC)^24.30^^^1 ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^INT^TAP^TELECOIL W/SWITCH (TWS)^22.00 ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^COM^MEM/S^MEMORY SWITCH (MS)^36^$%^ ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^MIC^SWM^DIRECTIONAL IMAGING W/SWITCH

(DS)^70.30^$

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^MTX^^102/40

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^MTX^^114/55

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^REM^^A1 REMOTE CONTROL

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^REM^^A2 REMOTE CONTROL

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^CHGR^^A1 CHARGER

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^CHGR^^A2 CHARGER

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^FIT^^OUR OWN FF1

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^FIT^^OUR OWN FF2

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^SO^HYPOALLERGENIC [STD]

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^WY^^(O)^(Y)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^SC^*PINK (V)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^SC^TAN (W)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^SC^CLEAR (H)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^FC^*PINK (V)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^FC^TAN (W)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^VC^*VOLUME CONTROL (VC)^^^^{&

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^VC^NO VC (NC)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^VN^PROBE VENT (PT)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^VN^*PRESSURE VENT (PR)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^VN^NO VENT (NV)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^DO^REMOVAL STRING/FILAMENT (RF) [STD]

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^BO^ZA13 (13) [STD]

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^WP^*WAX SPRING (WS)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^WP^PUSH IN WAX GUARD SYSTEM (PW)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^WP^BELL CANAL (BC)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^WP^EXTENDED RECEIVER TUBE (ER)^^^^{

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^CL^LONG CANAL (LC)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^CL^*MEDIUM CANAL (MC)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^CL^CANAL LENGTH AS MARKED (MK)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^SR^CANAL LOCK (CA)^^^^&

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^SR^RETENTION RING (RR)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^CS^SOFT SEAL/COAT (SS)^^^%

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^MP^WINDHOOD (WN)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^MP^*WINDSCREEN (WS)

ABC HEARING^BEST FS^422.00^0^1^2^N^CIC^WDRC15^FOCUS 2^^^MI^EARHOOK €

ABC HEARING^BEST WR^100^0^4^1^Y^^^^BEST WR.pdf^^SC^*PINK (V)

ABC HEARING^BEST WR^100^0^4^1^Y^^^^^^SC^SILVER (W)

ABC HEARING^BEST WR^100^0^4^1^Y^^^^^^SC^AQUA (H)

ABC HEARING^BEST WR^100^0^4^1^Y^^^^^^SC^CAMO (V)

ABC HEARING^BEST WR^100^0^4^1^Y^^^^^^SC^BLUE (W)

ABC HEARING^BEST WR^100^0^4^1^Y^^^^^^WY^^(O)ABC HEARING^A1 REMOTE CONTROL^59^0^6^^N^^^^A1 BEST REMOTE.pdf ABC HEARING^A2 REMOTE CONTROL^59^0^6^^N^^^^A2 BEST REMOTE.pdf ABC HEARING^A1 CHARGER^29^0^9^^N^^^^A1 BEST CHARGER.pdf ABC HEARING^A2 CHARGER^39^0^9^^N^^^^A2 BEST CHARGER.pdf

EOF (end of file indicator)

ATTACHMENT K

HEARING AID DATA TEXT FILE – VA DENVER LOGISTICS CENTER

*** PLEASE REVIEW THIS DOCUMENT PRIOR TO SUBMITTING A TEXT FILE ***

Contractors are required to submit their product data for Groups 1, 2, 3, 4, 6, 7, 8 and 9 to the DLC in a text file as described below. In the event of file errors, the contractor will be asked to correct and resubmit the file. Contractors are encouraged to submit their data file as soon as possible but no later than October 14, 2024 to the DLC IRM Division. Text file data (model names, components, ROES codes, etc.)

should match the publication sheets exactly. Please include all items on contract in the groups 1, 2, 3, 4, 6, 7,8 and 9, even if there are no changes from the previous file. Manufacturers may not use the text file to add or remove options or features or change prices of any devices unless that change has been approved by the contracting officer.

This data should be compiled into a single text file and should adhere to the following rules:

1. The data must be submitted in a text file (.txt extension) with data fields delimited by the up caret (“^”) character. The file name will follow this format:

(CONTRACT NUMBER-VENDOR NAME) HA FILE FOR (MONTHYYYY).TXT

Example

36C79119D0099-ADVANTAGE HA FILE FOR NOV 2024.TXT

2. Model names and component ROES codes should match the publication sheets exactly, including case.

3. Data entered into price fields should not contain commas or dollar signs.

4. The word “SHELL” causes problems with Department of Defense computer systems. Please abbreviate “SHELL” to “SHLL”.

5. The following characters are not allowed in primary and secondary feature names:

Semicolon ;

Back slash \ Forward slash / Single quotation ‘ Double quotation “” At sign @ Ampersand &

6. The maximum number of characters allowed for a segment must be adhered to.

7. There should be no blank lines in the file.

*** The last line in the file should contain an EOF (end of file) indicator and nothing else. ***

8. Wireless Systems, included in Group 4, should be included in the file as individual models. Use the “SC” category for color choices. There are currently no other feature categories that apply to wireless systems. Only use segments 1-5, 11, 13, 14, 15 and 16 for wireless systems.

9. Earmolds, included in Group 5, should NOT be included in this data file. These items will be submitted in a separate data file.

10. Simple Remote Controls, included in Group 6, should be included in the text file as an individual model and also in the “REM” segments to indicate that a remote is compatible with a hearing aid model. Only use segments 1-5 and 11 for remote controls.

11. Chargers, included in Group 9, should be included in the text file as an individual model and also in the “CHGR” segments to indicate that a charger is compatible with a hearing aid model. Only use segments 1-5 and 11 for chargers.

NOTE: Extra spaces before or after words make a difference! Please check to make sure there is only one space between the feature name and the standard “[STD]” designation in the flat file.

Make sure you are entering data in to the correct piece of the string.

E-mail the data file to dlc.hafiledrop@va.gov.

Description of Data Segments The data in the first 8 segments of the string contains the information specific to the model.

The data contained in segments 9-12 applies to the circuit on the hearing aid.

Segments 13-19 can be either primary features (components, interfaces and microphones), secondary features(colors, vents, battery options, etc.), remote controls and chargers that are available for that device, matrices or fitting formulas. Segment 13 may contain the code “COM” for “miscellaneous component”, “INT” for “interface”, “MIC” for “directional microphone”, “REM” for “remote control”, “CHGR” for charger, “MTX” for matrix, “FIT” for fitting formula or one of 15 secondary feature codes. The data in segments 14-19 will vary depending on the code entered in segment 13.

The inclusion of fitting formulas is optional.

Primary features include directional microphones, interfaces and components. The cost included with primary features only applies if the feature is ordered after the 180-day trial period (referred to as an “extra component order”). The code entered in segment 13 is used to build the appropriate drop down lists in ROES. Primary features will be displayed in ROES in the order listed in the flat file unless one is marked as a default.

Secondary features include items that may be added to a hearing aid as no-charge items. Some aids may not have any items that fit into a secondary feature category. ROES will display “none available” in the drop down if there are no secondary features for that category. Secondary features will be displayed in ROES in the order listed in the flat file unless one is marked as a default.

IMPORTANT NOTE: segment 14 holds the ROES code for Primary features but for Secondary features holds the name of the feature.

Fitting formulae – ROES will use only what you send us for a specific model, unless you send nothing, in which case we will generate a drop down with “NAL-R”, “NAL-NL1”, “NAL-NL2” and “DSL i/o”.

The following table contains a detailed description of the hearing aid data required by the DLC.

Explanation of Data Fields Model Information - segments 1-8

Data Element Description of Data Element 1 - Make Name of the make (vendor) appearing on the aid.

2 - Model Exact model name as it is listed on the publication sheets.

3 - Model Price Contract price of the model.

4 – Warranty* Enter 0

*this field was previously used for optional warranty periods that no longer exist 5 – Group/Fit Group as indicated on the contract and should be entered as a numeric 1,2,3,4,6,7,8. Groups are as follows:

Group 1 – Custom (CHA) Digital Hearing Aids Group 2 – Behind-the-Ear (BTE) Digital Hearing Aids Group 3 – Receiver-in-the-Canal (RIC) Digital Hearing Aids Group 4 – Wireless systems Group 6 – Simple remote controls Group 7 – CROS wireless transmitters Group 8 – CI compatible Devices Group 9 – Chargers

Fit applies to BTE aids only. “S” for “standard fit”, “O” for “open fit”, and “B” for “both”. Follow the Group number with a forward slash ( “/”) and the code letter for the fit (i.e. 2/O)

6 – Category Allowable values are 1, 2, 3, 4, 5 and blank. For Groups 5, 6 and 9 this element should be blank, otherwise for Groups 1-2 this element should contain the appropriate category number(1,2,3, or 4).

Group 3 this element should contain the appropriate category number (1, 2, 3, 4, or 5). Groups 4, 7 and 8 this element should contain the appropriate category number (1 or 2).

Group 1, 2 – Category 1 (Non-Rechargable) OR Category 2 (Rechargeable) OR Category 3 (Multiple Processor) OR Category 4 (SCIF) Group 3 – Category 1 (Non-Rechargable) OR Category 2 (Rechargeable) OR Category 3 (Multiple Processor) OR Category 4 (SCIF) OR Category 5 (Advanced Receiver) Group 4 – Category 1 (Wireless Systems) OR Category 2 (Wireless FM Systems) Group 7 – Category 1 (Non-Rechargeable) OR Category 2 (Rechargeable) Group 8 – Category 1 (Hearing Aids) OR Category 2 (Wireless Systems)

7 – External Battery Required? This indicates whether the item has a replaceable external battery. Allowable values are Y or N. If a replaceable battery is required use Y, otherwise use N.

8 - Shell Type The shell type will be “FS” for full shell, “HS” for half shell, “CAN” for canal, “CIC” for completely in the canal or “BTE” for behind the ear. Variants of the full shell (e.g., low profile) will be classified as “FS”. Variants of the canal (e.g., mini or micro-canal) will be classified as “CAN”.

RICs should be classified as “BTE”.

NOTE: “Low-profile”, “mini-canal” or “micro-canal” specifications can be made in the secondary feature category “miscellaneous”.

Circuits - segments 9-12 Data Element Description of Data Element

9 - Circuit ROES Code ROES code for the circuit as it appears on the publication sheets.

10 - Circuit Name Contractor's proprietary name for the circuit. (1-40 characters) 11 – Specification page name This is the name of a vendor supplied specification page that will be linked to the ROES ordering page for viewing by the clinician. The actual pages should be attached to an email and sent to dlc.hafiledrop@va.gov. Please include the file extension (i.e. .html, .pdf). Limit to 60 characters.

IMPORTANT: To link the PDF file to the model selected in ROES, please ensure that the file name in this field matches the name of the file sent in the email.

The specification page name need only be included on one line for the model/circuit combination.

12 – no longer used placeholder Primary Features, Matrices, Fitting Formula, Chargers and Remote Controls- segments 13-19

Data Element Description of Data Element 13 – Segment type code (MIC,INT,COM, REM, MTX,FIT,CHGR)

This code indicates the category of the data to follow. IT IS NOT THE ROES CODE.

MIC=microphone, INT=interface, COM=misc. component, REM=available remote controls, MTX=available matrices, FIT=vendor proprietary fitting formulas, CHGR=available chargers.

ROES will add fitting formulae if none are provided.

mailto:dlc.hafiledrop@va.gov

14 - Component ROES Code ROES code for the component according to the publication sheets. This field should be left blank for remote controls, chargers, matrices and fitting formulas.

15 - Component proprietary name Contractor's proprietary name for the component, charger(s) or remote control. This segment is also used to hold the available matrices or fitting formulas.

(1-40 characters) This component name may have the following additions:

Follow the component name with an internally used manufacturer code in parenthesis to help map it to your internal system. i.e. TINNITUS MASKER (TM) Follow the component name with one space and the designation "[STD]" to indicate that it is a standard feature that cannot be removed. Standard features will be pre-selected for the user in ROES. i.e. TINNITUS MASKER (TM) [STD] Prefix the component name with an “*” to designate a factory default. Factory defaults are displayed as the first item in the drop down list and are pre-selected for the user. i.e. *TINNITUS MASKER The user may de-select a factory default.

Factory defaults are automatically included on the order if the user does not deselect them. A feature designated with an “*” will be the first feature in the drop down list. Otherwise, features will be in the order that they are received in the flat file. This will allow you to keep like items grouped together.

IMPORTANT: Do not assign a [STD] designation to a primary feature that is a single selection field – use an “*” instead!

Matrices should be entered in the format output/gain/slope or just output/gain. The value for slope is optional. Multiple sets of matrices may be sent with each set on a separate line. Matrices are a mandatory field.

Fitting formulas that are proprietary may be included here. To default a particular fitting formula, prefix it with an asterisk “*”.

16 - Component Price Contract price of the component when ordered after the 180-day trial period. If it is a no-charge component, you may enter a zero or leave the field blank. Leave this segment blank for available remote controls, chargers, matrices and fitting formulas.

17 – Incompatibility characters You may assign incompatibility characters to primary features and also to matrices to indicate that they may not be selected along with another primary feature, secondary feature or matrix. You must assign the same character to all of the features that are incompatible. You may use only the following characters to assign incompatibility:

Asterisk, open parenthesis, close parenthesis, open curly braces, close curly braces, ampersand, dollar sign and percent sign, the numbers 1 through 9, and lowercase letters a through z.

* ( ) { } & $ % 1 2 3 4 5 6 7 8 9 a b c d e f g h i j k l m n o p q r s t u v w x y z

For example, if a specific directional microphone and a specific telecoil are incompatible, select an incompatibility character and enter it in segment 17 for both options.

If the directional microphone is also incompatible with a miscellaneous component, assign it a second incompatibility character and assign that same character to the miscellaneous component.

You may assign up to 15 incompatibility characters to one feature but keep in mind that errors are easy to make when you use more than a few . Do not separate the characters with commas or spaces. Segment 17 for a feature with multiple incompatibility characters may look like this: {28*&m

This segment should be left blank for remote controls, chargers and fitting formulas.

NOTE: It is not necessary to use incompatibility characters to keep the user from selecting two telecoils, earmolds or receivers because ROES already checks for this and alerts the user. ROES will only allow one telecoil to be selected unless the “allow two telecoils” flag is set (see below). The user also gets an alert if they do not select an earmold when earmolds are offered. RIC devices require a receiver to be selected.

18 – Compatibility characters You may assign compatibility characters to primary features and also to matrices to indicate that they should be selected along with another primary feature, secondary feature or matrix. You must assign the same character to all of the features that are compatible. You may use only the following characters to assign compatibility:

Asterisk, open parenthesis, close parenthesis, open curly braces, close curly braces, ampersand, dollar sign and percent sign, the numbers 1 through 9, and lowercase letters a through z.

* ( ) { } & $ % 1 2 3 4 5 6 7 8 9 a b c d e f g h i j k l m n o p q r s t u v w x y z

For example, if a specific directional microphone and a specific telecoil are recommended together, select a compatibility character and enter it in segment 18 for both options.

If the directional microphone is also recommended with a miscellaneous component, assign it a second compatibility character and assign that same character to the miscellaneous component.

When one of the features is selected the user will get a message that tells them that a second feature is recommended.

You may assign up to 15 compatibility characters to one feature but keep in mind that errors are easy to make when you use more than a few. Do not separate the characters with commas or spaces.

Segment 18 for a feature with multiple compatibility characters may look like this: {28*&m

This segment should be left blank for remote controls, chargers, matrices and fitting formulas.

19 – Allow two telecoils A “1” in this segment indicates that 2 telecoils are allowed for the circuit in segment 9 (otherwise ROES will only allow the user to select one.) You only need to enter this indicator on one “INT” line for each circuit listed.

Secondary Features - segments 13-16 Data Element Description of Data Element

13 - Secondary feature type code Shell Color (SC) – User may select one.

Shell Options (SO) – User may select multiple items.

Faceplate Color (FC) - User may select one.

Volume Control (VC) - User may select one.

Venting (VN) - User may select one.

Dexterity Options (DO) - User may select multiple items.

Battery Options (BO) - Battery names should be listed in the following terms: ZA5, ZA10, ZA13 User may select multiple items.

Wax Prevention (WP) - User may select multiple items.

Canal Length (CL) - User may select one.

Shell Retention (SR) - User may select one.

Comfort Seal (CS) - User may select one.

Mic Protection (MP) - User may select one.

RIC Items (RI) – User may select multiple items.

Open Fit Items (OF) – User may select multiple items.

Miscellaneous (MI) - This category may be used for any items that do not fit into the above categories. User may select multiple items.

Warranty codes (WY) – Although not actually a secondary feature, manufacturer internal codes for mandatory and optional warranties can be included in this category. Leave segment 14 blank and use segments 15 and 16 to indicate the warranty codes. These codes should be in parenthesis. These codes only need to be provided if the manufacturer would like them printed on the order form.

ROES alerts the user if no shell color is selected or if the shell color and faceplate color are different.

14 - Secondary feature name

This is the description of the secondary feature such as PINK, BROWN, RETENTION HOOK, WINDSCREEN, etc. An "*" before the name of the feature (*PINK) indicates a factory default. A designation of one space plus "[STD]" after the feature (HYPOALLERGENIC [STD]) indicates that the feature is a standard feature. If the contractor has an internal code for the feature that they would like to print out on the printed order form, it may be enclosed in parenthesis and follow the name of the feature (*PINK (P)).

Secondary features will be listed in ROES in the order they are sent in the flat file.

The standard and default designations do not apply to warranty codes.

1-50 characters.

Secondary feature item names are unique to each manufacturer and should be listed as they would appear on a printed order form. If an item applies to only the left side or only the right side, follow the item description with the pipe character “|” and an “L” or “R”. For example,” *RED (002)|R” and “*BLUE (003)|L” to indicate a default of a red shell color for the right and a blue shell color for the left. ROES allows a user to copy over the primary and secondary feature selections from one ear side to the other. Features labeled as left or right will not be able to be copied. Other features, however, will copy over.

15 – Mandatory period warranty code This segment may be used to indicate the manufacturer 's internal code for the mandatory warranty period (one or two years depending on the group) if the secondary feature category is "WY".

16 – Optional period warranty code* Leave this segment blank *This segment is no longer used. It was in use previously when optional warranty periods were included.

17 – Incompatibility characters You may assign incompatibility characters to a secondary feature to indicate that it may not be selected along with another secondary feature, matrix or primary feature. You must assign the same character to all of the features that are incompatible. You may use only the following characters to assign incompatibility:

Asterisk, open parenthesis, close parenthesis, open curly braces, close curly braces, ampersand, dollar sign and percent sign, the numbers 1 through 9, and lowercase letters a through z.

* ( ) { } & $ % 1 2 3 4 5 6 7 8 9 a b c d e f g h i j k l m n o p q r s t u v w x y z

For example, if a specific shell option and a wax protection option are incompatible, select an incompatibility character and enter it in segment 17 for both options.

If the shell option is also incompatible with a second wax protection option, assign it a second incompatibility character and assign that same character to the second wax protection option.

You may assign up to15 characters to one feature but keep in mind that errors are easy to make when you use more than a few . Do not separate the characters with commas or spaces. Segment 17 for a feature with multiple incompatibility characters may look like this: {28*&m

18 – Compatibility characters You may assign compatibility characters to a secondary feature to indicate that it should be selected along with another secondary feature, matrix or primary feature. You must assign the same character to all of the features that are compatible. You may use only the following characters to assign compatibility:

Asterisk, open parenthesis, close parenthesis, open curly braces, close curly braces, ampersand, dollar sign and percent sign, the numbers 1 through 9, and lowercase letters a through z.

* ( ) { } & $ % 1 2 3 4 5 6 7 8 9 a b c d e f g h i j k l m n o p q r s t u v w x y z

For example, if a specific shell option and a specific wax prevention option are recommended together, select a compatibility character and enter it in segment 18 for both options.

If the shell option is also recommended with a second wax prevention option, assign it a second compatibility character and assign that same character to the wax prevention option. When one of the features is selected the user will get a message that tells them that a second feature is recommended. ROES will not force the user to select compatible features.

You may assign up to 15 characters to one secondary feature but keep in mind that errors are easy to make when you use more than a few. Do not separate the characters with commas or spaces.

Segment 18 for a feature with multiple compatibility characters may look like this: {28*&m

ATTACHMENT L

EARMOLD DATA TEXT FILE – VA DENVER LOGISTICS CENTER (Jan 2019)

Contractors are required to submit their earmold data for Group 5 to the DLC in a text file as described below. In the event of file errors, the contractor will be asked to correct and resubmit the file. Contractors are encouraged to submit their data file as soon as possible but no later than Oct. 14, 2024 to dlc.hafiledrop@va.gov.

This data should be compiled into a single text file and should adhere to the following rules:

1. The data must be submitted in a text file (.txt extension) with data fields delimited by the up caret (“^”) character. The file name will follow this format:

(CONTRACT NUMBER-VENDOR NAME) EM FILE FOR (MONTHYYYY).TXT (abbreviate the month to 3 alphas) Example: VA791-19-D-1234-ADVANTAGE EM FILE FOR NOV2019.TXT

36C79119D0099-ADVANTAGE EM FILE FOR NOV 2024.TXT

2. Data entered into price fields should not contain commas or dollar signs.

3. The word “SHELL” causes problems with Department of Defense computer systems. Please abbreviate “SHELL” to “SHLL”.

4. The following characters are not allowed in any feature name:

Semicolon ;

Back slash \ Forward slash / Single quotation ‘ Double quotation “” At sign @ Ampersand &

5. The maximum number of characters allowed for a segment must be adhered to.

6. There should be no blank lines in the file.

NOTE: Extra spaces make a difference! Please check to make sure there is only one space between the feature name and the standard “[STD]” designation in the flat file. Make sure you are entering data in to the correct piece of the string.

E-mail the data file to dlc.hafiledrop@va.gov.

Description of Data Segments The first five pieces of the data string will be the style name of the earmold, the earmold ROES code, the earmold type, a flag to indicate if the receiver is replaceable in the clinic and the cost of that specific style.

These pieces will be duplicated on each line that follows with the features for that style. The feature code will be in piece 6, followed by the feature name in piece 7, the receiver price in piece 8, the receiver ROES code in piece 9, feature incompatibility characters in piece 10 and compatibility characters in piece

11. Piece 12 will hold the name of the technical specifications page. It is required on one line only. There is no limit to the number of features that you may include.

Feature names in any one category will be displayed in ROES in the order that they are listed in the flat file unless one is marked as a default. The ROES system will automatically insert “Select one” or “Select multiple” as the initial entry in the drop down list unless there is a default indicated. If a default is indicated, that item will be the first item in the list.

Each earmold style must have an entry for RIC, BTE and open fit BTE types of hearing aids.

Explanation of Data Fields

Earmold Information - segments 1-8 Data Element Description of Data Element 1 – Earmold Style Can be a proprietary name and can be up to 50 characters long. You may have the same style 3 times in this file, each with a different type (see segment 3). Each entry would have a different set of features, specific to that style and form factor. The name of the earmold style should match the earmold on the publication sheets. There will be a charge for the earmold if ordered after the 180 day trial period.

2 – Earmold ROES code This is the “EM” code for this style from the publication sheets. It should be the same for all hearing aid models.

3 - Earmold Type 1=RIC, 2=traditional BTE, 3=open fit BTE, 4=CROS 4 – Field replaceable receiver flag Place a 1 in this piece if the receiver is integrated and not field replaceable, otherwise leave blank 5 – Price of earmold Price for this earmold style. Do not include commas or dollar signs.

6 – Feature code The feature code may be any of the following:

“ET” – Tubing – user can select 1 “EM” – material – user can select 1 “EV” – venting – user can select 1 “EB” – bore – user can select 1 “EC” – color – user can select 1 “EW” – wax prevention – user may select multiple “ED” – dexterity options – user may select multiple “EL” – canal length – user may select 1 “EI” – miscellaneous – user can select multiple “ER” – list the receivers that are selectable for this earmold. There will be a charge for this receiver if the device is past the trial period or if not purchased through DALC. User may select 1.

7– Feature name The name of the feature may be proprietary. Limited to 50 characters including the code in parenthesis.

You may have as many features as you want in each of these categories.

An "*" before the name of the feature (*ACRYLIC) indicates a factory default. If the contractor has an internal code for the feature that they would like to print out on the printed order form, it may be enclosed in parenthesis and follow the name of the feature (*ACRYLIC (AC)). Standard features may be designated by following the name of the feature with a space and [STD].

8 – Receiver price This is the price of the receiver, if chargeable. Do not include dollar signs or commas. Leave blank if this feature is not a receiver.

9 – Receiver ROES code This is the code assigned to this receiver on the publication sheets. It should start with “REC” followed by a number and should be the same for all aids. Leave blank if this feature is not a receiver.

10 – Incompatibility characters You may assign incompatibility characters to an earmold feature to indicate that it may not be selected along with another earmold feature or hearing aid feature. You must assign the same character to all of the features that are incompatible. You may use only the following characters to assign incompatibility:

Asterisk, open parenthesis, close parenthesis, open curly braces, close curly braces, ampersand, dollar sign and percent sign, the numbers 1 through 9, and lowercase letters a through z.

* ( ) { } & $ % 1 2 3 4 5 6 7 8 9 a b c d e f g h i j k l m n o p q r s t u v w x y z

For example, if a specific venting option and a material option are incompatible, select an incompatibility character and enter it in segment 10 for both options.

If the venting option is also incompatible with a second material option, assign it a second incompatibility character and assign that same character to the second material option.

You may assign up to 15 characters to one earmold feature. Do not separate the characters with commas or spaces. Segment 10 for a feature with multiple incompatibility characters may look like this: {28*&m

11 – Compatibility characters You may also assign compatibility characters to a secondary feature to indicate that it should be selected along with another secondary feature or primary feature, or with an earmold feature. You must assign the same character to all of the features that are compatible. You may use only the following characters to assign compatibility:

Asterisk, open parenthesis, close parenthesis, open curly braces, close curly braces, ampersand, dollar sign and percent sign, the numbers 1 through 9, and lowercase letters a through z.

* ( ) { } & $ % 1 2 3 4 5 6 7 8 9 a b c d e f g h i j k l m n o p q r s t u v w x y z For example, if a specific earmold material and a specific wax prevention option are recommended together, select a compatibility character and enter it in segment 11 for both options.

If the material is also recommended with a second option, assign it a second compatibility character and assign that same character to the second option. When one of the features is selected the user will get a message that tells them that a second feature is recommended.

ROES will not force the user to select compatible features.

You may assign up to 15 characters to one secondary feature. Do not separate the characters with commas or spaces. Segment 11 for a feature with multiple compatibility characters may look like this: {28*&m

12 - Specification Page name This is the name of a vendor supplied specification page that will be linked to the ROES ordering page for viewing by the clinician. The actual pages should be attached to an email and sent to dlc.hafiledrop@va.gov. Please include the file extension (i.e. .html, .pdf). Limit to 60 characters.

IMPORTANT: To link the PDF file to the model selected in ROES, please ensure that the file name in this field matches the name of the file sent in the email.

The specification page name need only be included on one line for each earmold/type combination.

Below is an example of an Earmold Data file. Each feature category is shown in a different color if you are viewing this on-line or printing on a color printer. The incompatibilities and compatibilities are shown in red. In this example, the “hard acrylic” and the “bell bore” are incompatible and the “hard acrylic” is also incompatible with the “canal lock”. The material “silicone” and the color “clear” are compatible features.

SLIMTIP EARMOLD^EM2^1^1^32^ET^SLIM TUBE SIZE 1^^^^^RICSLIMTIP.PDF

SLIMTIP EARMOLD^EM2^1^1^32^ET^SLIM TUBE SIZE 2

SLIMTIP EARMOLD^EM2^1^1^32^EM^HARD ACRYLIC^^^&{

SLIMTIP EARMOLD^EM2^1^1^32^EM^SILICONE^^^^2

SLIMTIP EARMOLD^EM2^1^1^32^EV^LARGE VENT

SLIMTIP EARMOLD^EM2^1^1^32^EV^MEDIUM VENT

SLIMTIP EARMOLD^EM2^1^1^32^EV^SMALL VENT

SLIMTIP EARMOLD^EM2^1^1^32^EC^PINK

SLIMTIP EARMOLD^EM2^1^1^32^EC^TAN

SLIMTIP EARMOLD^EM2^1^1^32^EC^BROWN

SLIMTIP EARMOLD^EM2^1^1^32^EC^CLEAR^^^^2

SLIMTIP EARMOLD^EM2^1^1^32^EB^OPEN BORE

SLIMTIP EARMOLD^EM2^1^1^32^EB^HALF BORE

SLIMTIP EARMOLD^EM2^1^1^32^EB^BELL BORE^^^&

SLIMTIP EARMOLD^EM2^1^1^32^EW^EXT REC TUBE

SLIMTIP EARMOLD^EM2^1^1^32^EW^WAX TRAP

SLIMTIP EARMOLD^EM2^1^1^32^EW^SMARTGUARD

SLIMTIP EARMOLD^EM2^1^1^32^EL^LONG

SLIMTIP EARMOLD^EM2^1^1^32^EL^MEDIUM

SLIMTIP EARMOLD^EM2^1^1^32^EL^SHORT

SLIMTIP EARMOLD^EM2^1^1^32^ED^REMOVAL NOTCHES

SLIMTIP EARMOLD^EM2^1^1^32^ED^REMOVAL STRING

SLIMTIP EARMOLD^EM2^1^1^32^EI^CANAL LOCK^^^{

SLIMTIP EARMOLD^EM2^1^1^32^EI^DOME 6MM

SLIMTIP EARMOLD^EM2^1^1^32^EI^DOME 8MM

SLIMTIP EARMOLD^EM2^1^1^32^EI^DOME 10MM

SLIMTIP EARMOLD^EM2^1^1^32^EI^SOFT COAT

SLIMTIP EARMOLD^EM2^1^1^32^ER^HIGH POWER RECEIVER - SIZE 0^39^REC2

SLIMTIP EARMOLD^EM2^1^1^32^ER^HIGH POWER RECEIVER - SIZE 1^39^REC3

SLIMTIP EARMOLD^EM2^1^1^32^ER^HIGH POWER RECEIVER - SIZE 2^39^REC4

SLIMTIP EARMOLD^EM2^1^1^32^ER^SUPER POWER RECEIVER - SIZE 0^42^REC5

SLIMTIP EARMOLD^EM2^1^1^32^ER^SUPER POWER RECEIVER - SIZE 1^42^REC6

SLIMTIP EARMOLD^EM2^1^1^32^ER^SUPER POWER RECEIVER - SIZE 2^42^REC7

SLIMTIP EARMOLD^EM2^1^1^32^ER^STANDARD RECEIVER - SIZE 0^35^REC8

SLIMTIP EARMOLD^EM2^1^1^32^ER^STANDARD RECEIVER - SIZE 1^35^REC9

SLIMTIP EARMOLD^EM2^1^1^32^ER^STANDARD RECEIVER - SIZE 2^35^REC10

SLIMTIP EARMOLD^EM2^2^^32^ET^SLIM TUBE SIZE 1^^^^^BTESLIMTIP.PDF

SLIMTIP EARMOLD^EM2^2^^32^ET^SLIM TUBE SIZE 2

SLIMTIP EARMOLD^EM2^2^^32^EM^HARD ACRYLIC^^^&{

SLIMTIP EARMOLD^EM2^2^^32^EM^SILICONE

SLIMTIP EARMOLD^EM2^2^^32^EV^LARGE VENT

SLIMTIP EARMOLD^EM2^2^^32^EV^MEDIUM VENT

SLIMTIP EARMOLD^EM2^2^^32^EV^SMALL VENT

SLIMTIP EARMOLD^EM2^2^^32^EC^PINK

SLIMTIP EARMOLD^EM2^2^^32^EC^TAN

SLIMTIP EARMOLD^EM2^2^^32^EC^BROWN

SLIMTIP EARMOLD^EM2^2^^32^EC^CLEAR

SLIMTIP EARMOLD^EM2^2^^32^ED^REMOVAL NOTCHES

SLIMTIP EARMOLD^EM2^2^^32^ED^REMOVAL STRING

SLIMTIP EARMOLD^EM2^2^^32^EB^BELL BORE^^^&

SLIMTIP EARMOLD^EM2^2^^32^EL^LONG

SLIMTIP EARMOLD^EM2^2^^32^EL^MEDIUM

SLIMTIP EARMOLD^EM2^2^^32^EL^SHORT

SLIMTIP EARMOLD^EM2^2^^32^EI^CANAL LOCK^^^{

SLIMTIP EARMOLD^EM2^2^^32^EI^SOFT COAT

SLIMTIP EARMOLD^EM2^2^^32^EI^UNFILTERED TONE HOOK

SLIMTIP EARMOLD^EM2^3^^32^ET^SLIM TUBE SIZE 1^^^^^OFBTESLIMTIP.PDF

SLIMTIP EARMOLD^EM2^3^^32^ET^SLIM TUBE SIZE 2

SLIMTIP EARMOLD^EM2^3^^32^EM^HARD ACRYLIC^^^&{

SLIMTIP EARMOLD^EM2^3^^32^EM^SILICONE

SLIMTIP EARMOLD^EM2^3^^32^EV^LARGE VENT

SLIMTIP EARMOLD^EM2^3^^32^EV^MEDIUM VENT

SLIMTIP EARMOLD^EM2^3^^32^EV^SMALL VENT

SLIMTIP EARMOLD^EM2^3^^32^EC^PINK

SLIMTIP EARMOLD^EM2^3^^32^EC^TAN

SLIMTIP EARMOLD^EM2^3^^32^EC^BROWN

SLIMTIP EARMOLD^EM2^3^^32^EC^CLEAR

SLIMTIP EARMOLD^EM2^3^^32^ED^REMOVAL NOTCHES

SLIMTIP EARMOLD^EM2^3^^32^ED^REMOVAL STRING

SLIMTIP EARMOLD^EM2^3^^32^EB^BELL BORE^^^&

SLIMTIP EARMOLD^EM2^3^^32^EW^EXT REC TUBE

SLIMTIP EARMOLD^EM2^3^^32^EW^WAX TRAP

SLIMTIP EARMOLD^EM2^3^^32^EW^SMARTGUARD

SLIMTIP EARMOLD^EM2^3^^32^EL^LONG

SLIMTIP EARMOLD^EM2^3^^32^EL^MEDIUM

SLIMTIP EARMOLD^EM2^3^^32^EL^SHORT

SLIMTIP EARMOLD^EM2^3^^32^EI^CANAL LOCK^^^{

SLIMTIP EARMOLD^EM2^3^^32^EI^SOFT COAT

SLIMTIP EARMOLD^EM2^3^^32^EI^DOME 6MM

SLIMTIP EARMOLD^EM2^3^^32^EI^DOME 8MM

SLIMTIP EARMOLD^EM2^3^^32^EI^DOME 10MM

SKELETON EARMOLD^EM4^1^1^28^ET^SLIM TUBE - SIZE 1^^^^^RICSKELEM.PDF

SKELETON EARMOLD^EM4^1^1^28^ET^SLIM TUBE - SIZE 2

SKELETON EARMOLD^EM4^1^1^28^EM^HARD ACRYLIC^^^&{

SKELETON EARMOLD^EM4^1^1^28^EM^SILICONE

SKELETON EARMOLD^EM2^1^1^28^EV^LARGE VENT

SKELETON EARMOLD^EM2^1^1^28^EV^MEDIUM VENT

SKELETON EARMOLD^EM2^1^1^28^EV^SMALL VENT

SKELETON EARMOLD^EM4^1^1^28^EC^PINK

SKELETON EARMOLD^EM4^1^1^28^EC^TAN

SKELETON EARMOLD^EM4^1^1^28^EC^BROWN

SKELETON EARMOLD^EM4^1^1^28^EC^CLEAR

SKELETON EARMOLD^EM4^1^1^28^EB^BELL BORE^^^&

SKELETON EARMOLD^EM4^1^1^28^EB^OPEN BORE

SKELETON EARMOLD^EM4^1^1^28^EW^EXT REC TUBE

SKELETON EARMOLD^EM4^1^1^28^EW^SMARTGUARD

SKELETON EARMOLD^EM4^1^1^28^EW^WAX TRAP

SKELETON EARMOLD^EM4^1^1^32^EL^LONG

SKELETON EARMOLD^EM4^1^1^32^EL^MEDIUM

SKELETON EARMOLD^EM4^1^1^32^EL^SHORT

SKELETON EARMOLD^EM4^1^1^28^EI^CANAL LOCK^^^{

SKELETON EARMOLD^EM4^1^1^28^EI^SOFT COAT

SKELETON EARMOLD^EM4^1^1^28^ER^HIGH POWER RECEIVER - SIZE 0^39^REC2

SKELETON EARMOLD^EM4^1^1^28^ER^HIGH POWER RECEIVER - SIZE 1^39^REC3

SKELETON EARMOLD^EM4^1^1^28^ER^HIGH POWER RECEIVER - SIZE 2^39^REC4

SKELETON EARMOLD^EM4^1^1^28^ER^SUPER POWER RECEIVER - SIZE 0^42^REC5

SKELETON EARMOLD^EM4^1^1^28^ER^SUPER POWER RECEIVER - SIZE 1^42^REC6

SKELETON EARMOLD^EM4^1^1^28^ER^SUPER POWER RECEIVER - SIZE 2^42^REC7

SKELETON EARMOLD^EM4^1^1^28^ER^STANDARD RECEIVER - SIZE 0^35^REC8

SKELETON EARMOLD^EM4^1^1^28^ER^STANDARD RECEIVER - SIZE 1^35^REC9

SKELETON EARMOLD^EM4^1^1^28^ER^STANDARD RECEIVER - SIZE 2^35^REC10

[SECOND SECTION FOR SKELETON EARMOLD – BTE]

[THIRD SECTION FOR SKELETON EARMOLD – OF BTE]

DEPARTMENT OF VETERANS AFFAIRS - DENVER LOGISTIC CENTER

CONTRACTOR'S REPORT OF SALES – AUDIO OSSEOINTEGRATED IMPLANTS (AOI) Contract

1. Report For Period (Quarter / Year): QX / FYXX This report is required each quarter regardless of whether sales under the contract were made.

2. Contract No. 36C79121D00xx To:

FINANCE DIVISION (OO1AL-M1C)

VA DENVER LOGISTICS CENTER PO BOX 25166

DENVER, CO 80225-0166

4. Contractor Name, Address, & Zip Code

SALES REPORT (If no sales whatsoever for items awarded were made during the period covered by this report, enter "0" in approproate columns)

C

LI

N

C

LI

N D es cr ip tio n

5. Government Agency ( List Agencies)

D ep ar tm en t o f

V et er an s A ffa irs

( e xc lu di ng sa le s to D

A

LC

U .S

. A rm y

U .S

. N av y

U .S

. A ir

Fo rc e

In di an

H ea lth

Se rv ic e

H ea lth

H um an

Se rv ic es

Bu re au o f Pr is on

$0

$0

3 $0

4 $0

5 $0

$0

7. Grand Total Sales (sum of column 6) $0

8. Customer User Fee - Amount Due (3.5% of Total Sales) $0 Certification: As required by the contract terms, reported above are all Government sales for item(s) under contract.This report is accurate to the best of our knowledge and belieif.

Authorized Official (Print name and title)

Date

Signature Authorized Official

Phone: