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 .