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Includes instructions to complete and return the form as the first page, attach official receipts/invoices, and submit fully to avoid processing delays. Provides sections for sign-off by the person managing funds and for support worker/service provider details, including service types, hours, dates, amounts, subtotals, mileage, and signature confirmation. 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The support worker/service provider signs to acknowledge the services provided.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},335310,1790286235,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":20,"category_name":21,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},962085564807,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Fax: 1 (416) 943-6293  \nEmail: [invoices@familyservicetoronto.org](invoices@familyservicetoronto.org)  \n\n| Client Code | Client Name |\n| --- | --- |\n|  |  |\n\n\n| Payee Information |  |\n| --- | --- |\n| Name |  |\n| Address |  |\n| Phone Number |  |\n\nINSTRUCTIONS  \n• Fill out and return this form to be reimbursed for purchase of services.  \n• Always use this page as the first page for your submission.  \n• Attach official receipts / invoices as proof of purchase.  \n• Incomplete invoice forms will not be processed and will delay payment.  \n• If you have questions about the invoice, payment processing, or require any support, please contact your local Passport Agency.  \n\n| TOTAL NUMBER OF RECEIPTS / INVOICES |  |\n| --- | --- |\n| TOTAL AMOUNT OF RECEIPTS / INVOICES |  |\n\n\n| SIGNATURE-PERSON MANAGING FUNDS |  |\n| --- | --- |\n| By signing this form, I acknowledge that:\u003Cbr>• I have signed a Passport Service Agreement\u003Cbr>• I have not previously submitted the attached expenses\u003Cbr>• The attached expenses comply with the MCSS Passport Program Guidelines |  |\n| Signature of Person Managing Funds | Date |\n\n\n| NAME OF SUPPORT WORKER / SERVICE PROVIDER |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n| Name |  |  |  |  |  |\n| SUPPORT WORKER (SW) HOURS |  |  |  |  |  |\n| Complete one Passport Purchase of Service Form per worker\u003Cbr>Specify service type 1, 2 or 3 as per below.\u003Cbr>SERVICE TYPES\u003Cbr>1 Community participation supportsand activities of daily living\u003Cbr>2 Education e. g. tutoring, personal training, life skill development, job coaching\u003Cbr>3 Respite: in-home relief | Service Type | Start Date | End Date | Amount | Out of Province\u003Cbr>􀂆 |\n|  |  | Hours | Hourly Rate |  |  |\n|  | Service Type | Start Date | End Date | Amount | Out of Province\u003Cbr>􀂆 |\n|  |  | Hours | Hourly Rate |  |  |\n|  | Service Type | Start Date | End Date | Amount | Out of Province\u003Cbr>􀂆 |\n|  |  | Hours | Hourly Rate |  |  |\n|  | Service Type | Start Date | End Date | Amount | Out of Province\u003Cbr>􀂆 |\n|  |  | Hours | Hourly Rate |  |  |\n|  | Service Type | Start Date | End Date | Amount | Out of Province\u003Cbr>􀂆 |\n|  |  | Hours | Hourly Rate |  |  |\n|  | Subtotal |  |  | Amount |  |\n| MILEAGE |  |  |  |  |  |\n| Enter start and end dates, distance, rate and amount |  | Start Date | End Date | Amount | Out of Province\u003Cbr>􀂆 |\n|  |  | Distance (Km) | Rate |  |  |\n|  |  | Start Date | End Date | Amount | Out of Province\u003Cbr>􀂆 |\n|  |  | Distance (Km) | Rate |  |  |\n|  |  | Start Date | End Date | Amount | Out of Province\u003Cbr>􀂆 |\n|  |  | Distance (Km) | Rate |  |  |\n|  |  | Subtotal |  | Amount |  |\n| SIGNATURE |  |  |  |  |  |\n| By signing this invoice, I acknowledge that I have provided the services above.\u003Cbr>Signature of Support Worker / Service Provider |  |  |  | Date |  |\n\nCOMMUNITY PARTICIPATION  \n\n| Complete one line perinvoice/receipt\u003Cbr>Specify service type 4 ~ 10 as per below.\u003Cbr>SERVICE TYPES\u003Cbr>4 Community events and activities e. g. recreation, admission to festivals and museums, sports |  | Service Type | Name of agency / organization | Invoice / Receipt Number | Amount | Out of Province\u003Cbr>􀂆 |\n| --- | --- | --- | --- | --- | --- | --- |\n|  |  |  | Start Date | End Date |  |  |\n|  |  | Service Type | Name of agency / organization | Invoice / Receipt Number | Amount | Out of Province\u003Cbr>􀂆 |\n|  |  |  | Start Date | End Date |  |  |\n|  |  |  |  |  |  |  |\n| 5 | Day Programs e. g. programs provided by agency, classes, training, workshops, resume development and tests/licenses | Service Type | Name of agency / organization | Invoice / Receipt Number | Amount | Out of Province\u003Cbr>􀂆 |\n|  |  |  | Start Date | End Date |  |  |\n|  |  |  |  |  |  |  |\n| 6 | Membership | Service Type | Name of agency / organization | Invoice / Receipt Number | Amount | Out of Province |\n| 7 | Camp |  |  |  |  | 􀂆 |\n|  |  |  |  |  |  |  |\n| 8 | Out of home respite |  | Start Date | End Date |  |  |\n|  |  |  |  |  |  |  |\n| 9 | Transportation provided by agency, taxis, parking, public transit (not","cbCail9C0zLm6B7B","https://ap.wps.com/l/cbCail9C0zLm6B7B","pdf",132355,"English","# Instructions\n# Client and Payee Information\n# Totals and Managing Funds Signature\n# Support Worker / Service Provider Details\n## Service Types 1-3 and Hours\n## Mileage\n# Community Participation\n## Service Types 4-10\n# Person-Directed Planning\n# Administration\n# Other Claims","[{\"question\":\"What is required when submitting this invoice reimbursement form?\",\"answer\":\"Fill out and return the form for reimbursement, use it as the first submission page, and attach official receipts/invoices as proof of purchase.\"},{\"question\":\"What happens if the invoice form is incomplete?\",\"answer\":\"Incomplete invoice forms will not be processed and will delay payment.\"},{\"question\":\"Who must sign the form and what does their signature acknowledge?\",\"answer\":\"The person managing funds signs to acknowledge a passport service agreement, no prior submission of attached expenses, and that attached expenses meet program guidelines. The support worker/service provider signs to acknowledge the services provided.\"}]","Common - Invoice - Template - Final | PDF",1790010478]