Appendix-12- Billing Attestation Third-Final payment.docx
DOCX document 19 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 12 Billing Attestation/Activities Completed form for the third and final payment under the Housing Search Entities (HSE) program administered by the Massachusetts Rehabilitation Commission (MRC). The HSE program supports finding community-based housing for adults with disabilities and elders served by various MRC state-funded programs, including the Money Follows the Person (MFP-Demo) Demonstration grant and the Acquired Brain Injury (ABI) and Moving Forward Plan (MFP) Home and Community Based Services (HCBS) Waivers. The form requires signatures from the HSE staff and the Case Manager to confirm that the participant has signed a lease and the criteria for the third payment of $1,000 have been met.
The related state and local contract opportunity, titled "HOUSING SEARCH ENTITIES 5/22", seeks to create a pool of qualified HSEs to perform specific housing search tasks outlined in the solicitation. The contract is administered by the MRC in the state of Massachusetts. The contract term and any renewal options are not specified in the provided information.
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Text version
Appendix 12
Billing Attestation/Activities Completed HSE Part III Payment
Name of Individual:
Community Address:
Date of Move:
HSE Agency
HSE Assigned Staff
Staff completing this form
HSE Representative: My signature below indicates that this agency has met the criteria necessary for submission of request for the third payment ($1000.00) for HSE.
HSE Staff Signature Date
CM: My signature below indicates that the above HSE has met the criteria ( my participant has signed a lease) necessary for submission of request for the third payment for HSE.
Case Manager Signature Date Revised 4/2023
File details come from the government source that posted it. Updated .