VA244-17-R-1154-006.docx

ATTACHMENT #5

CONTRACT PHYSICIAN CERTIFICATION: IMMIGRATION AND NATIONALITY ACT OF 1952, AS AMENDED

1. The Contract Physician must certify that the Contract Physician shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contract Physician while providing services to Department of Veterans Affairs patient referrals;

0. Citizenship-related requirements. Each affected Contract Physician employee as described in paragraph shall be:

A United States (U.S.) citizen; or A national of the United States (see 8 U.S.C. 1408); or An alien lawfully admitted into the United States for permanent residence as evidenced by an Alien Registration Receipt Card Form I–151.

1. While performing services for the Department of Veterans Affairs, the Contract Physician shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States.

1. If the Contract Physician fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contract Physician’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contract Physician provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

1. The Contract Physician must obtain a similar certification from its sub Contract Physicians.

Typed Name and Title: __________________________________________ Company Name: ___________________________________________ This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.