D.4 VA CRS Extension Request Form.pdf
PDF 149 KB Posted
- Attached to
- G004--EMERGENCY CONTRACT SERVICES_HEALTH CARE HOMELESS VETERAN ST. LOUIS (VA-25-00001620)
- Solicitation number
- 36C25525Q0004
About this file
This is a VA Contract Residential Services (CRS) Extension Request Form used to request extensions for veteran housing services at the St. Louis VA Medical Center. The form requires submission to the VA CERS Liaison 7 days prior to the end of a previous referral period or when requested by the CERS Liaison.
The form captures key information including the veteran's details, bed days utilized, contract case manager information, housing goals and progress toward those goals, projected discharge date, referrals, and justification for the extension request. The bottom portion is reserved for Contracting Officer Representative (COR) use, featuring approval/denial checkboxes, processing date, comments section, and space for the Contract Case Manager's signature. This form appears to be a template supporting the broader Health Care for Homeless Veterans (HCHV) services contract opportunity.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .