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INDEPENDENT LIVING SUPPORTS PILOT (ILSP) DIRECTHIRE WORKER (DHW) & VENDOR CLAIM FORM Invoice #: DHW/VENDOR Name: EIN/SSN: DHW/VENDOR Address: ___ Participant Legal Name: Instructions: Please complete

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How to fill out ilsp dhw vendor claim

01

Obtain a copy of the ILSP DHW Vendor Claim form.

02

Fill in your personal information such as your name, address, and contact details.

03

Provide details of the services or products you provided as a vendor for the ILSP DHW program.

04

Include the amount you are claiming for each service or product provided.

05

Attach any necessary documentation such as invoices or receipts to support your claim.

06

Double check all the information provided and make sure it is accurate and complete.

07

Submit the completed ILSP DHW Vendor Claim form to the appropriate authority.

Who needs ilsp dhw vendor claim?

01

Vendors who have provided services or products for the ILSP DHW program and are seeking reimbursement or payment for their work.

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What is ilsp dhw vendor claim?

ILSP DHW vendor claim is a form submitted by vendors involved in the Distribution Hardware Vendor (DHW) program to claim reimbursements for eligible products that have been purchased.

Who is required to file ilsp dhw vendor claim?

Vendors who participate in the Distribution Hardware Vendor (DHW) program are required to file ilsp dhw vendor claims.

How to fill out ilsp dhw vendor claim?

ILSP DHW vendor claims can be filled out online through the designated vendor portal or submitted via mail with all required documentation attached.

What is the purpose of ilsp dhw vendor claim?

The purpose of ilsp dhw vendor claim is to request reimbursement for eligible products that vendors have purchased and supplied for the Distribution Hardware Vendor (DHW) program.

What information must be reported on ilsp dhw vendor claim?

ILSP DHW vendor claims must include details of the purchased products, invoice copies, proof of payment, and any other relevant documentation as required by the program guidelines.

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