Appendix-10- Billing Attestation first payment.docx
DOCX document 20 KB Posted
- Attached to
- HOUSING SEARCH ENTITIES 5/22
- Solicitation number
- BD-23-1071-MFP-MF00-89001
- Issued by
- Massachusetts
About this file
This document is an Appendix 10 Billing Attestation/Activities Completed for the Housing Search Entities (HSE) contract opportunity issued by the Massachusetts Rehabilitation Commission (MRC). The HSE is required to complete specific housing search tasks to assist in finding community-based housing for adults with disabilities and elders served by the MFP-Demo, ABI, and MFP HCBS Waiver programs. The attestation form lists the required activities that the HSE and Case Manager must validate have been completed in order to submit a request for the first payment of $500.00.
The related state and local contract opportunity seeks to create a pool of qualified HSEs to perform the housing search tasks outlined in the scope of work. This opportunity is open to vendors in the state of Massachusetts. No additional details on pricing, funding, or other salient information are provided in the given documents.
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Text version
Appendix 10
Billing Attestation/Activities Completed HSE Part I Payment
Name of Individual:
HSE Agency
HSE Assigned Staff
Staff completing this form
Activities completed as of are checked off below:
Assessed enrollee’s housing needs and preferences
Completed Housing Needs and Preference Assessment
Housing Search Roles and Responsibilities Agreement signed by the HSE and the individual
Secured Core Housing Documents (e.g., Photo id, birth certificate, social security card)
Recommended a specific list of three housing opportunities to pursue immediately
Completed and provided letter to the Individual & CM outlining housing options to pursue immediately
HSE Representative: My signature below indicates that this agency has completed all the activities listed above, the criteria necessary for submission of request for the first payment ($500.00) for HSE.
HSE Staff Date
CM: My signature below indicates that the above HSE has completed all the activities necessary for submission of the first payment for HSE activities.
Case Manager Date Revised 4/2023
File details come from the government source that posted it. Updated .