ESBD_520882_1779973882484_Attachment 02-OE Application Submission Checklist.pdf
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- Solicitation number
- 3202600155
- Issued by
- Texas
About this file
This is an Application Submission Checklist for the Texas Workforce Commission (TWC) Vocational Rehabilitation (VR) program, designed to assist applicants in preparing responsive applications for provider certification. The checklist serves as a reference tool to ensure completeness of submitted materials but is not itself a required attachment to the application. Applicants are responsible for independently reviewing all application requirements and submitting all necessary documentation to constitute a complete application package.
The checklist identifies twelve required forms and supporting documents that applicants must submit, including execution of application documentation, Internal Revenue Service W-9 and direct deposit forms, child support certification, TWC VR Standards for Provider Certification, conflict of interest and insurance certifications, entity headquarters information forms covering management and services operations, entity physical location certification and general information forms, and provider staff information forms with supporting documentation. All referenced forms utilize specific VR designation numbers (VR 1020, VR 1305, VR 3443 through VR 3455) for tracking and administrative purposes within the Texas Workforce Commission system.
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ATTACHMENT 2 - OE APPLICATION SUBMISSION
CHECKLIST
This Application Submission Checklist is provided to assist an Applicant in preparing a responsive Application. The checklist is not a requirement and does not need to be attached to the Application. Applicant is responsible for reviewing all Application requirements and ensuring it submits all materials for a complete Application.
□ Form 1 – Execution of Application
□ Form 2 – W-9 and Direct Deposit Form (VR 1020)
□ Form 3 - Child Support Certification (VR 1305)
□ Form 4 – TWC VR Standards for Provider Certification (VR 3443)
□ Form 5 – Conflict of Interest Certification (VR 3444)
□ Form 6 – Provider Insurance Certification (VR 3445)
□ Form 7 – Entity Headquarters Information Management Form
(VR 3441A)
□ Form 8 – Entity Headquarter Information – Services (VR 3441B)
□ Form 9 – Entity Headquarters Information – Location(s) (VR 3441C)
□ Form 10 – Entity’s Physical Location(s) – Part A – Service Contracts Certification (VR 3442A)
□ Form 11 – Entity’s Physical Location(s) – Part B – General Information Service Contracts (VR 3442B)
□ Form 12 – Provider Staff Information Form(s) with Supporting Documentation (VR 3455)
Attachment 2 - oe APPLICATION Submission Checklist
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