ATTACHMENT D - EXTENSION REQUEST - BLANK.docx
DOCX document 15 KB Posted
- Attached to
- G004--NEW RESIDENTIAL SERVICES BEDS (WOMEN)
- Solicitation number
- 36C26225R0075
About this file
The document is an Extension Request template for the VA Grant and Per Diem Program, specifically designed for requesting extensions of a Veteran's initial authorized residential service period. The template requires detailed documentation from the contractor, including comprehensive information such as justification for the extension, steps taken to house the Veteran, identified barriers, mitigation strategies, implementation plans with timelines, housing options (minimum of two plans), and confirmation of the Veteran's agreement with the proposed plan.
The extension request is part of a broader Department of Veterans Affairs solicitation (36C26225R0075) for New Residential Services Beds for Women, issued by the Veterans Health Administration's Network Contracting Office in Long Beach, California. The solicitation is set for response on 07-17-2025 at 3 PM Pacific Time, targeting NAICS code 624229 and product service code G004, with no Recovery Act funds or specific set-asides indicated. The extension request template is one of multiple attachments in the solicitation package, indicating a structured approach to managing residential services for Veterans.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT G- HOMES RESIDENTIAL TREATMENT REFERRAL WORKSHEET.docx | DOCX document | |
| ATTACHMENT B - CONTRACT RULES OF BEHAVIOR AGREEMENT.pdf | ||
| ATTACHMENT A - ADA ACCESSIBILITY CHECKLIST FOR EMERGENCY SHELTERS.pdf | ||
| D.3 REFERENCE CONTRACT WORKSHEET.docx | DOCX document | |
| S02 - 36C26225R0075 - RESIDENTIAL SERVICES updated 02.pdf | ||
| ATTACHMENT I - QUALITY ASSURANCE.docx | DOCX document | |
| ATTACHMENT H - INCIDENT REPORT.docx | DOCX document | |
| 36C26225R0075_2.docx | DOCX document | |
| ATTACHMENT F - ADMISSION DENIAL REFERRAL TRACKER.xlsx | XLSX spreadsheet | |
| ATTACHMENT E - SQUARES.pdf | ||
| ATTACHMENT K - SQUARES QUICK REFERENCES.pdf | ||
| ATTACHMENT J - RESIDENTIAL EXIT FORM WORKSHEET.doc | DOC document | |
| ATTACHMENT C - HEALTHCARE FOR HOMELESS VETERANS INCIDENT REPORT.docx | DOCX document |
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Text version
Extensions request protocol:
Extensions of the Veteran initial authorized period shall be requested in writing by the Contractor, with justification of the Veteran’s need and updated treatment plan. Approvals shall be authorized in writing by the VA Grant and Per Diem Program Manager/Contracting Officer Representative (COR).
Please complete the following and provide to the program liaison for review.
1. Justification of Veteran’s need for extension:
2. Steps taken to date to house veteran:
3. Barriers identified:
4. Plan to mitigate barriers:
5. Plan to be implemented during extension period: (please include timeline)
6. Housing plan: (please give a minimum of 2 housing plans)
7. Is veteran in agreement with plan?
File details come from the government source that posted it. Updated .