Attachment 6B_ Security_ServicesRequestForm_Supplemental.pdf
PDF 261 KB Posted
- Attached to
- Z1DA--NCO5 - MATOC II Federal contract opportunity
- Solicitation number
- 36C24524R0024
About this file
This document is a Supplemental Form 1B for a Contract Security Verification Request, to be used in conjunction with the signed Form 1A when there is a large roster of employees. The form collects information such as the employee name, social security number, email address, date of birth, and place of birth for personnel who require security verification for a Department of Veterans Affairs contract.
The related federal contract opportunity is for the NCO 5 MATOC II Multiple Site Solicitation 36C24524R0024, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 5. The solicitation is for an unspecified contract requirement. No additional details about the products, services, response dates, award dates, pricing terms, set asides, or incumbents are provided in the given documents.
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Text version
Revised Form January 2022
Department of Veterans Affairs
WMC HROO ELR Shared Services Unit WPersonnel Security
VSC.Security@va.gov
CONTRACT SECURITY VERIFICATION REQUEST SUPPLEMENTAL FORM #1B
(This form is used only when extra space is needed for large rosters and must be submitted with a signed form 1a.)
A Contracting Officer Name & Phone:
B COR Name & Phone:
C Task Order Number:
D Contract Company Name (Subcontractor):
E Contractor POC Name & Phone:
F G H I J Employee Name
(Full Legal Name) SSN Email Address D.O.B. Place of Birth (City, State/Country)
1b1:
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