Staff Information Form 650-25-75-05-25

(Revised 1/1/14 ML#3396)

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The Department of Human Services, Aging Services Division, requires the completion and submission of a Staff Information Form. The form identifies staff involved in providing a specific service.

 

Upon request, an organization chart (diagram form) that shows the structure of the organization, illustrating staff by title, lines of authority, and a current review date must be submitted.

 

The Staff Information Form will be forwarded to the legal entity through the procurement process. Throughout the contract term, the legal entity is responsible for updating and resubmission of any information contained on the Staff Information Form. The legal entity must submit changes using the Notification of Proposal Change Form.

 

Upon receipt of the resubmitted forms, the documents will be reviewed; acknowledgment of receipt and/or approval will be indicated by signature of the Director of Aging Services Division on the Notification of Proposal Change Form. A copy of the signed Notification of Proposal Change Form will be forwarded to the legal entity.

 

The new form(s) will become a part of the contract.