D4.4_Request for Extension of Per Diem Form.docx

This is a Request for Extension of Per Diem Form used to request extensions of the initial authorized period for Veterans receiving transitional housing services under the VA Greater Los Angeles Healthcare System's 30-bed Low Demand Safe Haven program (Solicitation #36C26226R0083). The form establishes a standardized protocol requiring Contractors to submit written extension requests with comprehensive documentation to the VA Grant and Per Diem Program Manager/Contracting Officer Representative (COR) for written approval.

The extension request requires Contractors to provide seven key components: a written justification of the Veteran's need for continued housing services; a summary of steps already taken to house the Veteran; identification of barriers preventing permanent housing placement; a mitigation plan to address those barriers; specific plans to be implemented during the extension period with associated timelines; a minimum of two alternative housing plans; and confirmation of the Veteran's agreement with the proposed plan. This documentation ensures that extensions are based on demonstrated need, documented progress toward housing stability, and realistic pathways to permanent housing placement within the Department of Veterans Affairs' transitional housing framework.