2-Appendix AA.pdf

APPENDIX AA

Standard_Appendices(AppendixAA) 7/19

INVOICING SUBMISSION REQUIREMENTS

Per your preference, invoices may be sent via mail OR email as follows:

Invoices submitted via mail to:

Accounts Payable Department Department of Human Services Administration 20 South 69th Street, 4TH Floor Upper Darby, PA 19082

Invoices submitted electronically to:

Delcohsa_ap@delcohsa.org

*NOTE: TO AVOID DUPLICATION DO NOT SEND THE INVOICE IN BOTH

FORMATS AND DO NOT COPY OTHER INDIVIDUALS

Basic Invoice Requirements

• All invoices must be signed, dated and include a unique invoice number as well as the County Program Office and Program Name

• All invoices must include a coversheet if client specific data is included (See sample attached of both Fee for Service & Cost Reimbursement invoice coversheets)

• All invoices must include detail to support amount due – as per directed / mandated by your Assigned Program / Fiscal County Staff

Additional Electronic Submission Requirements

• Submit invoices separately, one email for each invoice

• Invoice must be in PDF format only; any other format will be rejected by Accounts Payable

• Email subject line must include your Agency’s name, County Program / Program name for which the invoice is being submitted, Invoice #, Invoice Date and Invoice amount

APPENDIX AA

Standard_Appendices(AppendixAA) 7/19

COST REIMBURSEMENT INVOICE COVER SHEET

((Provider letterhead, address, etc))

To: Accounts Payable Delaware County Department of Human Services 20 South 69th Street, 4th Floor Upper Darby, PA 19082

DHS PROGRAM OFFICE:

PROGRAM NAME:

INVOICE DATE:

INVOICE #

SERVICE MONTH:

INVOICE AMOUNT: $

((Signature)) ((Title))