D.10 REQUEST FOR EXTENSION.pdf
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- Solicitation number
- 36C25525R0104
About this file
The document is a VA CRS Extension Request Form used to request an extension for a veteran's referral in the Healthcare for Homeless Veterans (HCHV) Contract Emergency Residential Services (CERS) program. The form requires completion by the Contract Case Manager, who must provide details including the veteran's information, bed days, housing goals, progress toward those goals, projected discharge date, and a justification for the requested extension. The form includes sections for both the Contract Case Manager to fill out and a separate section for Contracting Officer Representative (COR) use, with fields for approval/denial and processing date.
This form is specifically related to the Solicitation Number 36C25525R0104 for HCHV Services Contract Emergency Residential Services at the Marion VA Medical Center's Evansville Health Center. The contract is a firm-fixed price Indefinite Delivery/Indefinite Quantity (IDIQ) solicitation with one base year and four one-year option periods, aimed at providing residential services for homeless veterans.
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Text version
VA CRS Extension Request Form
Complete form and email to VA CERS Liaison 7 days prior to the end of previous referral or if requested by CERS Liaison.
Veteran: Bed Days:
Contract Case Manager:
Housing goals:
Progress toward housing goals:
Justification for extension:
COR use only below this line
Date of Request:
Projected discharge date: Referrals:
Approved: Denied: Date processed:
Comments:
Contract CM Signature:
File details come from the government source that posted it. Updated .