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ATTACHMENT 4

PROPOSAL INTENT RESPONSE SHEET

RFP No. AHRQ-08-10032

Please review the attached request for proposal.  Furnish the information requested below and return this page by June 11, 2008.  Your expression of intent is not binding but will greatly assist us in planning for the proposal evaluation.

[  ]  INTEND TO SUBMIT A PROPOSAL

[  ] DO NOT INTEND TO SUBMIT A PROPOSAL FOR THE FOLLOWING REASONS:

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

[  ] I GRANT PERMISSION TO THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY, CONTRACTS OFFICE TO ADD THE CONTACT INFORMAION BELOW TO A BIDDERS LIST TO PROVIDE TO OTHER INTERESTED OFFERORS FOR TEAMING/SUBCONTRACING OPPORTUNITIES. (*MUST INCLUDE AUTHORIZED SIGNATURE)

COMPANY/INSTITUTION NAME & ADDRESS:

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

*AUTHORIZED SIGNATURE: __________________________________

TYPED/PRINT NAME AND TITLE: ______________________________

DATE: ___________________

[  ] PLEASE DO NOT RELEASE THE CONTACT INFORMATION.

Please return to: Jessica Alderton
AHRQ, Contracts Management
540 Gaither Road
Rockville, Maryland 20850
301-427-1740 (fax)
E-Mail: jessica.alderton@ahrq.hhs.gov

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