D.1 ATTACHMENT A - VA CONTRACTOR BACKGROUND INVESTIGATION REQUEST WORKSHEET.pdf
PDF 89 KB Posted
- Solicitation number
- 36C10X26R0001
About this file
This document is a Contractor Background Investigation Request form from the VA Security and Investigations Center. The form is designed to collect comprehensive personal and professional information for a contractor background investigation, including individual details (SSN, name, birth information, citizenship), company information (contractor company, point of contact, address), and Contracting Officer/Contracting Officer's Representative (CO/COR) contact information. The form requires detailed input across multiple sections, with fields for investigation type, position title, task order number, and various contact methods, enabling the VA to conduct thorough background screenings for contractors seeking to work within their organization.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10X26R0001 0003.pdf | ||
| D.10 ATTACHMENT K_PRICE SCHEDULE_Rev2.xlsx | XLSX spreadsheet | |
| 36C10X26R0001 0002.pdf | ||
| 36C10X26R0001 0001 B.pdf | ||
| D.10 ATTACHMENT K_PRICE SCHEDULE_Rev1.xlsx | XLSX spreadsheet | |
| D.10 ATTACHMENT K_PRICE SCHEDULE_Sept 30, 2025.xlsx | XLSX spreadsheet | |
| D.9 ATTACHMENT J - PAST PERFORMANCE QUESTIONAIRRE.docx | DOCX document | |
| D.4 ATTACHMENT D_LIMITATIONS ON SUBCONTRACTING_CERTIFICATE FOR SERVICES.docx | DOCX document | |
| D.5 ATTACHMENT E_AFFIRMATION STATEMENT.docx | DOCX document | |
| D.2 ATTACHMENT B - FY26 VA INFORMATION SECURITY RULES OF BEHAVIOR.pdf | ||
| 36C10X26R0001.pdf | ||
| D.8 ATTACHMENT H - PAST PERFORMANCE REFERENCES.pdf | ||
| 36C10X26R0001_1.docx | DOCX document | |
| D.7 ATTACHMENT G - WAGE DETERMINATION.docx | DOCX document | |
| D.6 ATTACHMENT F_BUSINESS ASSOCIATE AGREEMENT.pdf | ||
| D.3 ATTACHMENT C SAMPLE REFERRAL LANGUAGE_Sept 22, 2025.docx | DOCX document |
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Text version
Contractor Background Investigation Request
VA Organization Billing Information
| Organization: [ ] |
| Station: |
| Station Label: Station # |
| Date Label: Current Date: |
| Date: |
| Organization Label: VA Organization |
| City Of Birth Label: City of Birth |
| Date of Birth Label: Date of Birth |
| Company POC Label: Company POC |
| Company POC Email Label: POC Email Address |
| Company City Label: City |
| Company Zip Label: Zip |
| Last Name: |
| Middle Name: |
| Country of Birth: [ ] |
| City of Birth: |
| Date of Birth: |
| Company State: [ ] |
| First Name: |
| Company State Label: State |
| Last Name Label: Last Name |
| Middle Name Label: Middle Name |
| First Name Label: First Name |
| SSN Label: SSN |
| SSN: |
| Gender: |
| Gender Label: Gender |
| Email Address: |
| Country of Citizenship: [ ] |
| Country Of Birth Label: Country of Birth |
| State of Birth Label: State of Birth |
| Email Address Label: Email Address |
| Country of Citizenship Label: Country of Citizenship |
| Position Title Label: Position Title |
| Company POC: |
| Position Title: |
| Priority Label: Priority |
| Child Care Label: Child Care |
| Priority: Off |
| Child Care: Off |
| Individual Information Label: Individual Information |
| Company Information Label: Company Information |
| COR Information: CO / COR |
| COR Email Label: CO / COR Email |
| COR Address 1 Label: CO / COR Address 1 |
| COR Address 2 Label: CO / COR Address 2 |
| COR Name Label: Name of CO / COR |
| COR Phone Label: CO / COR Phone Number |
| COR Station Label: CO / COR Station # |
| COR State: [ ] |
| State of Birth: [ ] |
| COR State Label: State |
| COR City Label: City |
| COR Zip Label: Zip |
| Company Zip: |
| Company City: |
| COR City: |
| COR Address 1: |
| COR Zip: |
| COR Address 2: |
| Company POC Email: Use semicolons for multiple addresses. |
| COR Email: Use semicolons for multiple addresses. |
| COR Name: |
| COR Station: |
| State Instructions: Leave blank if foreign born. |
| Options Label: Additional options may be presented after an investigation is selected. |
| Investigation Label: Investigation |
| Investigation: [Select One...] |
| COR Phone: |
| Contractor Company Label: Contractor Company |
| Contractor Company: |
| Task Order Number Label: Task Order Number |
| Task Order Number: |
| POC Address Label: POC Address |
| POC Address: |
| Phone Number Label: Phone Number |
| Phone Number: |
| Reinvestigation Label: Reinvestigation |
| Reinvestigation: Off |
| Include SAC Label: Include SAC |
| Include SAC: Off |
File details come from the government source that posted it. Updated .