ESBD_548201_1786394359998_Attachment 02-OE Application Submission Checklist.pdf
PDF 4 MB Posted
- Attached to
- Open Enrollment (OE) for Employment Services
- Solicitation number
- 3202600194
- Issued by
- Texas
About this file
This is an Application Submission Checklist for Open Enrollment (OE) for Employment Services with the State of Texas. The checklist is designed to assist applicants in preparing complete and responsive applications by outlining all required forms and supporting documentation. Applicants must submit 12 forms including execution of application, W-9 and direct deposit information, child support certification, Texas Workforce Commission VR standards for provider certification, conflict of interest certification, provider insurance certification, entity headquarters information management forms, entity physical location certification and information forms, and provider staff information forms with supporting documentation. The checklist is provided as a guide only and is not a requirement to be attached to the application; however, applicants remain responsible for reviewing all application requirements and ensuring submission of all materials necessary for a complete application.
No specific information regarding pricing terms, set-asides, incumbents, funding amounts, or contract term and renewal options is contained in this checklist document, as it functions solely as a reference tool for applicants to track required submissions rather than detailing the substantive terms and conditions of the employment services contract opportunity.
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Text version
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)
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