Vendor Management Intake Form

Form Approved
OMB No. 0990Exp. Date XX/XX/20XX

HHS Office of the Chief Information Officer (OCIO)
Vendor Management Office (VMO) - Vendor Intake Form

Purpose: The Department of Health and Human Services (HHS), Office of the Chief Information Officer (OCIO) is
regularly contacted by vendors offering product and services demonstrations. The purpose of this document is to
provide potential vendors to the HHS/OCIO organizations a format in which to submit company information to be
reviewed by OCIO staff. OCIO staff can then arrange demonstrations as their schedules permit. Collection of this
data is for informational purposes only and does not indicate any potential for business opportunities within HHS,
OCIO or any subordinate organizations. A repository of collected information will be maintained by the HHS/OCIO/
Vendor Management Office (VMO): [email protected]
All requests to communicate with OCIO representatives must include the following information:

Company Name:
Point of Contact Name:
Contact Title:
Contact Phone Number:
Contact Email Address:
Company Website:
NAICS Codes:
Duns Number:
CAGE Number:
SBA Socio-economic Designations:
If any, such as:
8a, HubZone, other OSDBU Designations
Service or Product Description (keep to one paragraph)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0990-0379. The time required to complete this information collection is estimated to average 30 minutes per response, including the
time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy
of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite
336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

HHS Office of the Chief Information Officer (OCIO)
Vendor Management Office (VMO) - Vendor Intake Form

Keywords Search:
Links or Demos to Additional Information:
Infographics via Links, if available:
Contact Phone Number:
Target Market, please include:
- What HHS/OCIO component will your service or product benefit? Include examples; identify specific HHS activities, as applicable
- Who are your most frequent users?
- Who has benefitted the most thus far?

Established Use Cases (optional):
- Link use cases to HHS/OCIO mission areas

Current Contract Vehicles Performing Under:
- Include references with contact information