8-Verification of Sex Offender Treatment Services Performed (Individual).pdf
PDF 172 KB Posted
- Attached to
- RFP - Sex Offender Treatment Services for the Harris County Community Supervision & Corrections Department
- Solicitation number
- 25/0129
- Issued by
- Harris County, Texas
About this file
This is a service verification form from the Harris County Community Supervision and Corrections Department for documenting sex offender treatment services. The form serves as official documentation that a client has received specific services including sex offender assessment, sex offender evaluation, individual counseling, or other specified services from qualified staff members. The form requires signatures from both the client receiving services and the staff member providing services, along with essential client identification information including the client's printed name, SPN number, contract tracer number, and assigned officer.
The form functions as a billing verification mechanism, with explicit instructions that all original verification of service forms must be attached to invoices submitted for payment. This indicates the form is part of a contractual payment system where services are documented and verified before reimbursement can occur. The form does not specify contract terms, pricing structures, or funding sources, but serves as the foundational documentation required for the payment process in what appears to be a contracted sex offender treatment program administered by Harris County's community supervision system.
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Text version
HARRIS COUNTY COMMUNITY SUPERVISION AND CORRECTIONS DEPARTMENT
VERIFICATION OF SEX OFFENDER TREATMENT SERVICES PERFORMED
DATE: ______________
This is to verify that I met with a staff member of on the above date.
And received the following services:
_______ Sex Offender Assessment _______ Sex Offender Evaluation
_______ Individual Counseling
Other (specify):
SIGNED:
Signature of client receiving service Client’s printed name
Client’s SPN# Client’s Contract Tracer #
Client’s Officer
Name of Staff Member Providing Service Date
NOTE: PLEASE ATTACH ALL ORIGINAL VERIFICATION OF SERVICE
FORMS TO INVOICES SUBMITTED FOR PAYMENT.
File details come from the government source that posted it. Updated .