Price Schedule Form.xlsx

XLSX spreadsheet 46 KB Posted

Attached to
Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) Survey
Solicitation number
RFQ-BFSU-26-007
Issued by

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Written by GovTribe AI ·

The file is a Price Schedule Form for a Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) Survey contract issued by the Indian Health Service for the Blackfeet Service Unit (BFSU) in Browning, Montana. The solicitation is a 100% small business set-aside for a Firm Fixed Price purchase order with a base period from December 1, 2025, through November 30, 2026, and four potential 12-month option years extending through November 30, 2030.

The contract scope includes monthly HCAHPS phone mode surveys of up to 60 patients, including maintenance and reporting, with a one-time implementation, set-up, and data transfer component. The pricing template is currently blank, indicating that vendors will need to fill in their proposed unit prices. The estimated inflation rate is 2.25% per year, and the contract was prepared by Eva Racine on August 14, 2025. The procurement will be conducted under NAICS code 621498 for Outpatient Care Centers, with a small business size standard of $25.5 million.

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Other files

File Type Posted
A05 - SOW_HCAHPS_BFSU.pdf PDF
B11 - IEE Representation.pdf PDF

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IGCE

HHS IGCE TEMPLATE
Project Title:BFSU HCAHPS
Location:BFSU, Browning MT 59417
Period of PerformanceUltimate Start:12/1/25Ultimate End:11/30/30
Note: This template can be modified based on the contract type (i.e. Firm Fixed Price, Time and Materials, and Cost Reimburesment)
Contract Line Item Description+A6Base PeriodOption Year OneOption Year TwoOption Year ThreeOption Year Four
QuantityUnitUnit PriceTotal PriceQuantityUnitUnit PriceTotal PriceQuantityUnitUnit PriceTotal PriceQuantityUnitUnit PriceTotal PriceQuantityUnitUnit PriceTotal Price
HCAHPS Phone Mode Surveys; Up to 60 patients surveyed monthly, Maintenance and Reporting12.00MO$ - 012.00MO$ - 012.00MO$ - 012.00MO$ - 012.00MO$ - 0
Implementation, Set-up and Data Transfer1.00EA$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Line Item Subtotal$ - 0$ - 0$ - 0$ - 0$ - 0
Fringe Benefits$ - 0$ - 0$ - 0$ - 0$ - 0
Subtotal Line Item & Fringe$ - 0$ - 0$ - 0$ - 0$ - 0
Overhead$ - 0$ - 0$ - 0$ - 0$ - 0
Subtotal Line Items, Fringe and Overhead$ - 0$ - 0$ - 0$ - 0$ - 0
OTHER DIRECT COSTS
Travel$ - 0$ - 0$ - 0$ - 0$ - 0
Subcontracts$ - 0$ - 0$ - 0$ - 0$ - 0
Consultants$ - 0$ - 0$ - 0$ - 0$ - 0
Materials$ - 0$ - 0$ - 0$ - 0$ - 0
CDs$ - 0$ - 0$ - 0$ - 0$ - 0
Subtotal ODCs$ - 0$ - 0$ - 0$ - 0$ - 0
Subtotal - All Costs$ - 0$ - 0$ - 0$ - 0$ - 0
G&A$ - 0$ - 0$ - 0$ - 0$ - 0
Total Cost$ - 0$ - 0$ - 0$ - 0$ - 0
Fee/Profit$ - 0$ - 0$ - 0$ - 0$ - 0
Total Estimated Yearly Values$ - 0$ - 0$ - 0$ - 0$ - 0
TOTAL ESTIMATED VALUE OF CONTRACT$ - 0
Assumptions:Percent
Inflation Rate Per Year2.25%Estimate Prepared by:Eva Racine
Fringe Benefits Rate0.00%Date Prepared:8/14/25
Overhead Rate0.00%
G&A Rate0.00%Signature:Eva Racine
Fee/Profit Percentage0.00%

&F&D&T

File details come from the government source that posted it. Updated .