D.7 ATTACHMENT D - EXTENSION REQUEST - BLANK.docx
DOCX document 15 KB Posted
- Attached to
- G004--RESIDENTIAL BEDS (WOMEN)
- Solicitation number
- 36C26226R0013
About this file
The document is an Extension Request form for a VA Grant and Per Diem Program related to residential services for veterans. The form requires contractors to provide detailed documentation when requesting an extension of a veteran's initial authorized period, including comprehensive information such as justification for extension, steps taken to house the veteran, identified barriers, mitigation plans, implementation timeline, housing options, and veteran agreement.
The related federal contract opportunity (Solicitation Number 36C26226R0013) is for Residential Service Beds specifically for Women, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 22. The solicitation is located in Long Beach, California, with performance to be conducted at the VA Greater Los Angeles Healthcare System. Key details include a response deadline of 11-24-2025 at 10 AM Pacific Time, NAICS code 623220, product service code G004, and no Recovery Act funds or set-asides specified. The primary point of contact is Danielle Carroll, reachable at Danielle.Carroll4@va.gov.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26226R0013 0003.docx | DOCX document | |
| 36C26226R0013 0002.docx | DOCX document | |
| 36C26226R0013 0001_1.docx | DOCX document | |
| D.14 ATTACHMENT K - SQUARES QUICK REFERENCES.pdf | ||
| D.10 ATTACHMENT G- HOMES RESIDENTIAL TREATMENT REFERRAL WORKSHEET.docx | DOCX document | |
| D.8 ATTACHMENT E - SQUARES.pdf | ||
| D.6 ATTACHMENT C - HEALTHCARE FOR HOMELESS VETERANS INCIDENT REPORT.docx | DOCX document | |
| S02 - 36C26226R0013 - NEW RESIDENTIAL SERVICES - WOMEN.pdf | ||
| D.13 ATTACHMENT J - RESIDENTIAL EXIT FORM WORKSHEET.doc | DOC document | |
| D.9 ATTACHMENT F - ADMISSION DENIAL REFERRAL TRACKER.xlsx | XLSX spreadsheet | |
| D.5 ATTACHMENT B - CONTRACT RULES OF BEHAVIOR AGREEMENT.pdf | ||
| D.12 ATTACHMENT I - QUALITY ASSURANCE.docx | DOCX document | |
| D.11 ATTACHMENT H - INCIDENT REPORT.docx | DOCX document | |
| D.4 ATTACHMENT A - ADA ACCESSIBILITY CHECKLIST FOR EMERGENCY SHELTERS.pdf | ||
| 36C26226R0013_1.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 .