I&E AND MIP QUARTERLY INVOICE SUBMISSION INSTRUCTIONS WITH EXAMPLE INVOICE COVER LETTER
Please follow these instructions to ensure that your invoice is processed without delay. 1. Print the invoice – Your invoice should consist of a summary page, signed by the project director and the fiscal officer, and two detail pages. 2. Complete the invoice cover letter – Using the attached example cover letter, enter all of the information and print it on agency letterhead. The letter must be signed by your agency’s authorized signatory as indicated on the revised Agency Information Form (AIF). 3. Include a “Time Study-Data Report” page for each person being invoiced. 4. If the invoice includes reimbursement for any equipment, it must be accompanied with a completed HAS 1203 form (CDPH-funded Contractor equipment). 5. Submit the following documents stapled together: Cover Letter, Quarterly Invoice, Time Study-Data Report (one for each staff you are billing for), and HAS 1203 Form if applicable, to your assigned contract manager at the following address: Center for Family Health California Department of Public Health Office of Family Planning Attn: (Insert Contract Manager Name) 1615 Capitol Avenue, MS Code 8305 P.O. Box 997420 Sacramento, CA 95899-7420 If you have any questions regarding these instructions, please contact your contact manager as soon as possible.
Center for Family Health California Department of Public Health Attn: Choose One 1615 Capitol Avenue, MS Code 8305 P.O. Box 997420 Sacramento, CA 95899-7420
RE:
Invoice Submittal for the Office of Family Planning (OFP) Grant Agreement Number .
Enclosed for payment is our ( Choose One) invoice in the total amount of $
,
which covers the period of (Choose One), inclusive dates for services rendered pursuant to the terms and conditions established in the above referenced OFP Workplan and Budget. If you have any questions regarding this invoice, please contact at ( ).
Sincerely,
Type your name here Choose One