Get Southeasttrans Request For Qualifications Application

This guide provides clear and concise instructions on how to complete the Southeasttrans Request For Qualifications Application online. It aims to assist users of all experience levels in accurately filling out this important document.

Follow the steps to successfully complete your application

1. Use the ‘Get Form’ button to obtain the application and open it in your preferred document editor.
2. Begin by selecting your service area from the provided options, which include regions in Georgia and specific programs such as Peach Care for Kids and DHS - Fulton County.
3. In the classification section, indicate the type of application you are submitting: new, anniversary, renewal, or revision.
4. Select the mode of transportation that your services will cover. Options include ambulatory, wheelchair, stretcher, and bariatric stretcher.
5. Complete the ownership section by identifying your organization type. This may include options such as individual, partnership, corporation, LLC, state government, county government, hospital authority, or non-profit.
6. Provide the name and contact details of the owner, including email address, street address, business phone, city, state, zip code, and fax.
7. If applicable, fill in the details for the authorized agent, including their name, email address, street address, business phone, city, state, zip code, and fax.
8. Answer the basic qualifications section by indicating whether the owner or any party has had any certifications revoked or disciplinary actions taken against them. If yes, attach relevant documentation.
9. Continue through the operational information section by providing the name of the service, the number of vehicles, and business hours.
10. Confirm whether there are any existing contracts with other agencies related to patient transportation services.
11. Complete the business location section, if different from the ownership address, providing the street address, county, level of care, city, state, zip code, and zoned provider.
12. List any service area interests, including counties, cities/areas, and facilities of interest.
13. Provide reimbursement information, including the federal tax identification number, email address, and address details related to the check pick-up preference.
14. Fill in the manifest/trip request section with details including the agency name, contact representative's information, and address.
15. In the certification section, sign and date the application appropriately, ensuring you use blue ink as required.
16. Once all sections are complete, save your changes, and choose to download, print, or share the application as needed.

Get started today by completing the Southeasttrans Request For Qualifications Application online.