ESBD_547773_1786134193455_Attachment 02-OE Application Submission Checklist.pdf
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- Attached to
- 3202600208 Open Enrollment (OE) for Assistive Technology (AT) Services for Customers with Visual Impairments
- Solicitation number
- 3202600208
- Issued by
- Texas
About this file
This document is an Application Submission Checklist prepared by the State of Texas for the Open Enrollment (OE) for Assistive Technology (AT) Services for Customers with Visual Impairments contract opportunity. The checklist serves as a guide to assist applicants in preparing a complete and responsive application submission. The checklist is not mandatory and does not require submission with the application itself; however, applicants are responsible for reviewing all application requirements and ensuring submission of all required materials. The document lists twelve forms that applicants must complete and submit, including execution of application, W-9 and direct deposit information, child support certification, provider certification standards, conflict of interest and insurance certifications, entity headquarters information across multiple categories, physical location certifications and information, and provider staff information with supporting documentation.
The required forms utilize standardized state forms with specific form numbers and versions assigned by the Texas Workforce Commission (TWC), indicating a structured procurement process with defined compliance and administrative requirements. No pricing information, contract terms, renewal options, award dates, response deadlines, or site visit details are contained within this checklist document. The checklist functions solely as an organizational tool to ensure applicants submit all necessary documentation and certifications required for consideration in the open enrollment process.
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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
File details come from the government source that posted it. Updated .