J2 OCR Separation Checklist.docx
DOCX document 38 KB Posted
- Solicitation number
- 75P00123R00048
About this file
This document is an employee separation checklist for the Department of Health and Human Services Office for Civil Rights. It outlines the required steps for contractors leaving the agency to return any issued equipment or property. Contractors must indicate all items assigned to them such as laptops, monitors, phones, scanners, and printers and note whether the items are located in their home office or HHS office. For any items located at a home office, contractors must provide their mailing address, non-HHS email, and phone number so the agency can arrange return shipment. All other owned assets and items like PIV cards, office keys, and non-OCIO property must be returned directly to the separating employee's supervisor. Contractors should direct any other questions to the OCR IT help desk email address provided.
The related federal contract opportunity is for executive services and consulting support for the HHS Office of Civil Rights. The solicitation number listed is 75P00123R00048 and was issued by the Department of Health and Human Services Office of the Assistant Secretary for Administration.
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| File | Type | Posted |
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| 75P00123R00048 Amendment 02.pdf | ||
| J6 Revised Questions and Answers.pdf | ||
| J7 SF1449.pdf | ||
| J1_Past Performance Questionnare.docx | DOCX document | |
| J8 Wage Determination 2015-4281.pdf | ||
| J6 Questions and Answers.pdf | ||
| 75P00123R00048 Amendment 01.pdf | ||
| J4 Revised IDIQ - Executive Services Consulting - SOW - TO1.pdf | ||
| J5 Revised Pricing Scenario.xlsx | XLSX spreadsheet | |
| J3_Contractor Performance Self-Assessment Template.pdf | ||
| J5 Pricing Scenario.xlsx | XLSX spreadsheet | |
| Synopsis solicitation 75P00123R00048 r1.pdf | ||
| J1_Past Performance Questionnare.docx | DOCX document | |
| J4 IDIQ - Executive Services Consulting - SOW - TO1.pdf |
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Text version
ATTACHMENT J.2
Department of Health and Human Services Office for Civil Rights
OCR Contractor Employee Separation Checklist Office Equipment:
· Indicates required information.
* Name:
* Last official date:
* Supervisor / Project Manager:
Room Number:
· Please check all items that you have been assigned and where it is located (Home OR HHS office).
| OCIO Owned Assets: |
| Home Office |
| HHS Office |
| Laptop |
| ☐ |
| ☐ |
| Bag |
| ☐ |
| ☐ |
| Dell Monitor |
| ☐ |
| ☐ |
| Docking Station w/power supply |
| ☐ |
| ☐ |
| Travel Power Supply |
| ☐ |
| ☐ |
| Mouse |
| ☐ |
| ☐ |
| Keyboard |
| ☐ |
| ☐ |
| iPhone |
| ☐ |
| ☐ |
| Headset |
| ☐ |
| ☐ |
OCR Owned Assets:
| ViewSonic Monitor |
| ☐ |
| ☐ |
| Fujitsu ScanSnap - Scanner |
| ☐ |
| ☐ |
| MiFi |
| ☐ |
| ☐ |
| Desktop Printer |
| ☐ |
| ☐ |
| Office / Cabinet Keys |
| ☐ |
| ☐ |
Other Assets (Please List):
| ☐ |
| ☐ |
| ☐ |
| ☐ |
OCIO Owned Assets:
The following information is required if any OCIO Owned Assets are located at your home office.
Mailing Address:
A box will be sent to this address in order to get your OCIO equipment back to HHS.
Non-HHS Email Address:
Non-HHS Telephone Number:
NOTE: OCIO does not accept Non-OCIO property. Do not send these items back to OCIO with your laptop and other equipment!
ATTACHMENT J.2
Department of Health and Human Services Office for Civil Rights
PIV Card:
· Please provide the following information related to your HHS PIV card:
PIV Personal ID:
The 10 digit number is located on the back of your PIV Card under “Personal Identifier”.
Returning Items:
NOTE:
OCIO does not accept PIV Cards and Non-OCIO property.
Do not send these items back to OCIO with your laptop and other equipment!
All OCR Owned and Other Assets listed must be returned to your Supervisor / Project Manager.
Contact you Supervisor / Project Manager to return the PIV Card, office / cabinet keys, and any other non-OCIO owned property back to the office.
Please direct any questions to the OCR IT Department OS-OCRORIT@hhs.gov image1.jpeg
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