[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-335685-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-335685-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","childcare-invoice-official-form-template","Childcare Invoice - Official Form Template","","This document provides a formal, structured template designed for the reimbursement of childcare services within a professional workforce development framework, specifically associated with NCWorks and the Rivers East Workforce Development Board. The form facilitates a three-way verification process involving the childcare provider, the participant receiving the services, and a career advisor. Sections are clearly delineated for provider certification, participant validation, and administrative authorization, including specific fields for payment details, identification numbers, and fund coding. By requiring both provider and participant signatures, the document establishes a legally binding attestation that services were rendered and received. The inclusion of fraud warning language underscores the document's official capacity as a record for financial reimbursement, ensuring that all reported childcare expenses are accurately represented for processing by staff and supervisors. 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Please include your payment information below. Pay to:    \nAddress:   Provider Name:   Provider Title:   Provider Signature:   Date:    \nTo be completed by participant  \nI certify that the above stated childcare services were received as stated. I understand that if I knowingly falsify information or withhold information to qualify for reimbursement for which I am not entitled, I will be subject to penalties provided for fraud.  \nParticipant Signature:   Date:    \nTo be completed by Career Advisor  \nAmount to Be Reimbursed: $  Fund Code:    \nThis document serves as authorization to make childcare services payments. I have made the computations based on the information given to me by the childcare provider and the participant and it appears to be an accurate representation of the services provided during the period indicated.  \nStaff Signature:   Date:   Supervisor Signature:   Date:","cbCaijUMayNxb0zW","https://ap.wps.com/l/cbCaijUMayNxb0zW","pdf",108670,"English","# Childcare Provider Certification\n## Payment Information\n# Participant Certification\n## Fraud Warning\n# Career Advisor Authorization\n## Reimbursement and Fund Coding","[{\"question\":\"Who is required to sign the Childcare Invoice form?\",\"answer\":\"The form requires signatures from the childcare provider, the participant receiving the services, and the reviewing career advisor or supervisor.\"},{\"question\":\"What information must the childcare provider supply?\",\"answer\":\"The provider must include their name, state-issued ID number, details of the child(ren) served, service dates, weekly charge, and payment remittance information.\"},{\"question\":\"What is the purpose of the participant's certification section?\",\"answer\":\"The participant confirms that the listed childcare services were received and acknowledges that providing false information to secure reimbursement is subject to fraud penalties.\"}]","Childcare Invoice - Official Form Template | PDF",1790011939]