TABLE OF CHANGES – INSTRUCTIONS
NICCS Vendor Vetting Form
OMB Number: 1670-0030
04/30/2022
Reason for Revision: Fee Rule Project Phase:
Legend for Proposed Text:
Expires 4/30/2022 Edition Date 08/07/2020 |
Current Page Number and Section |
Current Text |
Proposed Text |
Vendor Vetting Form, Paragraph 1 |
[Paragraph 1]
… Vendor Vetting Form To ensure the quality of the NICCS Education and Training Catalog, the NICCS Supervisory Office (NICCS SO) has created a set of vetting criteria. This criterion ensures that the courses listed in the catalog are offered by organizations that are recognized as providing quality resources, while not excluding small or medium sized organizations.
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[Paragraph 1]
… Provider Vetting Form To maintain the quality of the NICCS Education and Training Catalog, the NICCS Supervisory Office (NICCS SO) has created a set of vetting criteria. This criterion ensures courses listed in the catalog are offered by organizations recognized for providing quality resources, while not excluding small or medium sized organizations.
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Contact Information Section |
Contact Information Form
CONTACT INFORMATION * The asterisk indicates a required field. Organization
Name *
Organization
Street Address *
City
*
U.S. States/Territories *
Zip
Code *
Organization
URL *
Primary
Point of Contact (POC) First and Last Name *
Phone
*
Email * Alternate
Primary POC Phone
Alternate Primary POC Email Address Secondary
POC Name
Secondary POC Email Address Secondary
POC Phone
Alt.
Phone
Alt. Email
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Contact Information Form
CONTACT INFORMATION * The asterisk indicates a required field. Organization
Name *
Organization
Street Address *
City
*
U.S. States/Territories *
Zip
Code (5 digit)*
Organization
URL *
Primary
Point of Contact (POC) First and Last Name *
Phone
(XXX-XXX-XXXX)
*
Email (email@email.com) * Alternate POC First and Last Name*
Alternate POC
Phone
Alternate POC Email Address
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Vendor Qualifications Section |
Vendor Qualifications To help ensure each provider listed is a legitimate business, any provider wishing to be listed in the NICCS portal must meet one of the following. (Please check all that are applicable.) Legitimate Business *
OR (must meet all of the following): OR select options
…
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Provider QualificationsThis section assists the NICCS SO to review provider qualification Please check the option that applies to your organization for the NICCS SO to confirm it is a legitimate business. *
Please check all the below that are performed by your organization. *
…
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Vendor Acknowledgement Section |
Vendor Acknowledgments To be considered for inclusion on NICCS, check each box to confirm the organization does each of the following: Vendor Acknowledgments Check Boxes *
Exclusion Option *
Withdraw Option *
The following is to be completed by an authorized representative of the provider: I acknowledge I have read and understood the contents of this template, and have been given full opportunity to discuss the implications of this consent with any and all decision makers of my organization, and the information above is truthful and accurate. NAME
(Last, First) *
Title
*
Date
*
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Provider Acknowledgements
To be considered for inclusion on the NICCS Education and Training Catalog, potential providers must acknowledge CISA’s exclusion criteria and rights by reviewing the below and checking the corresponding check box. Check the box below to demonstrate acknowledgement of CISA’s exclusion criteria*
Check the box below to demonstrate acknowledgement of CISA’s right to deny or remove training providers from the NICCS Education and Training Catalog*
Check the box below to demonstrate acknowledgement of CISA’s endorsement policy
Your participation in the NICCS Catalog does give you permission to use the Department of Homeland Security (DHS) Seal or CISA Logo. Furthermore, your participation in the Catalog does not imply an endorsement from DHS or CISA. Unauthorized use of the Seal/Logo or false statements of endorsement may result in removal from the Catalog. Check the box below to demonstrate acknowledgement of CISA’s dispute procedures
The following is to be completed by an authorized representative of the provider.
I acknowledge I have read and understood the contents of this application and have been given full opportunity to discuss the implications of this content with any and all decision makers of my organization. I also acknowledge that the information above is truthful and accurate. Authorized Representative Name (Last, First)*
Form Field Place Holder Authorized Representative Title*
Form Field Place Holder Submission Date*
Form Field Place Holder
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Carter, Pea Meng |
File Modified | 0000-00-00 |
File Created | 2021-01-13 |