REQUIRED ATTACHMENTS AND APPENDICES. Attachment 1: MBE, WBE, and/or Disability Enterprise Participation Plan • Attachment 2: Copy of 501(c)(3) Non‐Profit Status • Attachment 2: A completed and signed W‐9 downloaded from the RI Division of Purchases Internet home page at xxx.xxxxxxxxxx.xx.xxx. • Attachment 3: Staff resumes and job descriptions • Attachment 4: DUNS number and an active registration in the federal System for Award Management (XXX) Applications, which are incomplete in any material respect, will be deemed non‐responsive and will not be considered APPENDIX A. NEWBORN DEVELOPMENTAL RISK ASSESSMENT CRITERIA (LEVEL ONE SCREENING) Risk Positive (+) are infants with: Any 1 of the following: Developmental disabilities and certain other established conditions Birth weights less than 1500 grams (3.3 lbs) Intensive care hospitalization greater than 48 hours Hepatitis B surface antigen positive mother Any 2 of the following: Care giver’s education less than 11th grade Mother’s age less than 19 or greater than 37 Single Care giver Mother’s number of live births greater than 5 or no other live births One parent characteristic, e.g. chronic illness Less than 6 prenatal care visits before 36 weeks or total number less than 10 No prenatal care visits before 5 months Gestational age greater than 37 weeks and birth weight 1500‐2500 grams (3.3‐5.5 lbs) Apgars at 1 and 5 minutes less than 7 Medicaid Eligible Clinical Information is also included in the determination. APPENDIX B. FIRST CONNECTIONS POPULATION AND RISK CHARACTERISTICS Service Area Percent of Risk Positive Births on Public Insurance East Bay 58% East Urban Core 81% Kent/Washington Counties 53% Northern RI 67% West Urban Core 80% Note: These regions reflect the defined service areas for this new solicitation, however the percentages are based on data from 2017 births. Note: there are eight priority populations used to define these key risk factors:
REQUIRED ATTACHMENTS AND APPENDICES. Attachment 1: MBE, WBE, and/or Disability Enterprise Participation Plan [Appendix A] • Attachment 2: Copy of 501(c)(3) Non-Profit Status • Attachment 2: A completed and signed W-9 downloaded from the RI Division of Purchases Internet home page at xxx.xxxxxxxxxx.xx.xxx. • Attachment 3: Staff resumes and job descriptions • Attachment 4: DUNS number and an active registration in the federal System for Award Management (XXX) • Attachment 5: Outcome Monitoring Measurement Tools • Attachment 6: Signed Partner/Collaborative Agreement(s) • Attachment 7: List of designated staff with title, name, qualification, job description, resume and xxxxx of Qualified Professional Test Counselor (QPTC) Certification • Attachment 8: Budget Worksheet [Appendix F] • Attachment 9: Budget Narrative Worksheet • Attachment 10: Other Funding Sources Applications, which are incomplete in any material respect, will be deemed non-responsive and will not be considered APPENDIX A. PROPOSER ISBE RESPONSIBILITIES AND MBE, WBE, AND/OR DISABILITY BUSINESS ENTERPRISE PARTICIPATION FORM
