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