INVOICE AND PAYMENT. A. Grantee will request payment using the State of Texas Purchase Voucher (Form B-13) on a monthly basis and acceptable supporting documentation for reimbursement of the required services/deliverables. Additionally, the Grantee will submit the Financial Status Report (FSR-269A) and the Match Certification Form (B-13A). Vouchers, supporting documentation, Financial Status Reports, and Match Certification Forms should be mailed or emailed to the addresses below. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx, Xxx.xxxxxxxxxxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx B-13, B-13A, and supporting documentation should be sent to: xxxxxxxx@xxxx.xxxxx.xxx, Xxx.xxxxxxxxxxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx FSRs should be sent to: xxxxxxxx@xxxx.xxxxx.xxx, Xxx.xxxxxxxxxxxxxx@xxxx.xxxxx.xxx, XXXXxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx
B. Grantee will be paid on a monthly basis and in accordance with Attachment B, Budget.
C. System Agency reserves the right, where allowed by legal authority, to redirect funds in the event of financial shortfalls. System Agency will monitor Xxxxxxx’s expenditures on a quarterly basis. If expenditures are below that projected in Grantee’s total Contract amount, Xxxxxxx’s budget may be subject to a decrease for the remainder of the Term of the Contract. Vacant positions existing after ninety days may result in a decrease in funds.
X. Xxxxxxx may request a one-time working capital advance not to exceed 12% of the total amount of the Contract funded by System Agency. All advances must be expended by the end of the Contract term. Advances not expended by the end of the Contract term must be refunded to System Agency.
X. Xxxxxxx will repay all or part of advance funds at any time during the Contract’s term. However, if the advance has not been repaid prior to the last three months of the Contract term, the Grantee must deduct at least one-third of the remaining advance from each of the last three months’ reimbursement requests. If the advance is not repaid prior to the last three months of the Contract term, System Agency will reduce the reimbursement request by one- third of the remaining balance of the advance.
INVOICE AND PAYMENT. X. Xxxxxxx will request payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xx.xx/grants/forms.shtm. Voucher and any supporting documentation will be mailed or submitted by fax or electronic mail to all addresses/number below. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xx.xx and EMAIL: XXXXxxxxxxx@xxxx.xxxxx.xxx and EMAIL: XXXXX.Xxxxxxxxx@xxxx.xxxxx.xxx
B. Grantee will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract.
X. Xxxxxxx will submit requests for reimbursement (Form B-13) and financial expenditure template monthly by the last business day of the month following the month in which expenses were incurred or services provided. Grantee shall maintain all documentation that substantiate invoices and make the documentation available to the DSHS upon request. In the event a cost reimbursed under the Contract is later determined to be unallowable then the Grantee will reimburse DSHS for that cost.
X. Xxxxxxx will submit quarterly Financial Status Reports (FSRs) to DSHS by the last business day of the month following the end of each quarter of the Contract for DSHS review and financial assessment.
X. Xxxxxxx will submit request for reimbursement (B-13) as a final close-out invoice not later than forty-five (45) calendar days following the end of the term of the Contract. Reimbursement requests received in the DSHS office more than forty- five (45) calendar days following the termination of the Contract may not be paid.
X. Xxxxxxx will submit a final FSR as a final close-out FSR not later than forty-five
INVOICE AND PAYMENT. A. Grantee shall establish and maintain an independent cost center that is accessible and identifies the source and application of funds provided under this Statement of Work and original source documentation substantiating that costs are specifically and solely allocable to this Statement of Work and are traceable from the transaction to the general ledger.
B. Grantee shall request monthly payments on or before the 15th day of the month after the month of service (e.g., September submission due October 15th), and within the budget period specified in Grantee’s NTP using the State of Texas Purchase Voucher Form 4116, which is incorporated by reference and can be downloaded at: xxxxx://xxx.xxxxx.xxx/laws- regulations/forms/4000-4999/form-4116-state-texas-purchase-voucher.
C. Documentation and data required for invoice submission includes:
1. Name, address, and telephone number of Grantee on the State of Texas Purchase Voucher Form 4116;
INVOICE AND PAYMENT. Grantee will request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation shall be submitted to DSHS no later than 30 days after the last day of each month.
X. Xxxxxxx will request payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xx.xx/grants/forms/b13form.doc. Voucher and any supporting documentation will be mailed or submitted by fax or electronic mail to the address/number below. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx & XXXxxxxxxxx@xxxx.xxxxx.xxx
B. Grantee will email the Financial Status Report (FSR-269A) and the Match Certification Form (B-13A) to the following: Xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Grantee must submit final FSR and a reimbursement or final payment request no later than 45 calendar days following the end of the Contract term.
X. Xxxxxxx will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. Attachment C (the “HHSC Uniform Terms and Conditions - Grants”), is hereby revised as follows:
INVOICE AND PAYMENT. A. Grantee shall establish and maintain an independent cost center that is accessible and identifies the source and application of funds provided under this Statement of Work and original source documentation substantiating that costs are specifically and solely allocable to this Statement of Work and are traceable from the transaction to the general ledger or other workpaper accounting for the use of funds.
B. Grantee shall submit invoices based on the schedule outlined in Table 1 using the State of Texas Purchase Voucher Form 4116, which is incorporated by reference and can be downloaded at: xxxxx://xxx.xxx.xxxxx.xxx/regulations/forms/4000-4999/form-4116- authorization-expenditures.
C. All invoices not received by the scheduled due date as outlined in Table 1 above are considered late and will require justification from the Grantee for the late submission.
D. Documentation and data required for invoice submission includes:
1. Name, address, and telephone number of Grantee on the State of Texas Purchase Voucher Form 4116;
INVOICE AND PAYMENT. Grantee shall:
A. Request payments monthly using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm, the Voucher Support Form (VSF) and acceptable supporting documentation for reimbursement of the required services/deliverables. Grantee is required to identify expenditures by budget category and funding code. Voucher and all supporting documentation must be submitted to: P.O. Box 149347 Austin, TX 78714-9347 E-mail: xxxxxxxx@xxxx.xxxxx.xxx and xxxxxxxxxxx@xxxx.xxxxx.xxx;
B. Be paid on a cost reimbursement basis and in accordance with Attachment B-1 of this Contract (i.e., Budget); and
C. Submit to DSHS an annual forecast of all program income generated from DSHS funds and activities. Program income should be expended prior to drawing down or requesting reimbursement from DSHS. Grantee must also make available
1. Report to the contract manager assigned to the Contract, any knowledge of debarment, suspected fraud, program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, rules, policies, and procedures related to performance under this Contract;
2. Make such report no later than three (3) working days from the date the Grantee has knowledge or reason to believe such activity has taken place;
3. Report any credible evidence that a principal, employee, subgrantee or agent of Grantee, or any other person, has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds; and
4. Make this report to the SAO at xxxx://xxx.xxxxx.xxxxx.xxx and to the HHS Office of Inspector General at xxxx://xxx.xxx.xxx.xxx/fraud/hotline/ no later than three
INVOICE AND PAYMENT. A. Grantee shall submit requests for reimbursement of required services/deliverables monthly using the State of Texas Purchase Voucher (Form B-13), together with supporting documentation as directed by System Agency. Forms should be mailed, faxed or e-mailed to the addresses below. Invoices will be due the last business day of the month following the month in which expenses were incurred.
B. Grantee shall submit a Financial Status Report (FSR) twice per calendar year for the term of the Contract, beginning on the effective date of the Contract through November 30, 2027. 1 Effective Date - May 31, 2023 June 30, 2023 June 1, 2023 - November 30, 2023 December 30, 2023 2 December 1, 2023 - May 31, 2024 June 30, 2024 June 1, 2024 - November 30, 2024 December 30, 2024 3 December 1, 2024 - May 31, 2025 June 30, 2025 June 1, 2025 - November 30, 2025 December 30, 2025 4 December 1, 2025 - May 31, 2026 June 30, 2026 June 1, 2026 - November 30, 2026 December 30, 2026 5 December 1, 2026 - May 31, 2027 June 30, 2027 June 1, 2027 - November 30, 2027 January 15, 2028 All reporting documents must be submitted by e-mail, fax, or mail. E-mail is preferred, but fax or mail is acceptable.
1. For submission by mail, use address below: Department of State Health Services Claims Processing Unit, MC 1940 X.X. Xxx 149347 Austin, TX 78714-9347
2. For submission by fax, use number below: (000) 000-0000
3. For submission by e-mail, see requirements below:
a. Form B-13 with supporting documentation and Form B-13A must be sent to xxxxxxxx@xxxx.xxxxx.xxx & XXXXxxxxxxx@xxxx.xxxxx.xxx, with a copy to the System Agency contract manager.
b. FSR must be sent to: xxxxxxxx@xxxx.xxxxx.xxx; XXXXxxxxx@xxxx.xxxxx.xxx; and with a copy to the System Agency contract manager.
C. Grantee will be reimbursed monthly in accordance with Attachment B, Budget, subject to all Contract requirements, applicable law and governing regulations. Grantee shall include required and appropriate documentation with all reimbursement requests.
INVOICE AND PAYMENT. A. Grantee shall request monthly payments by the last business day of the month following the month in which expenses were incurred and shall use the State of Texas Purchase Vouchers (Form B-13 and Form B-13A) located at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Xxxxxxx’s final invoice will be due thirty (30) calendar days following the expiration date of the Grant Agreement. System Agency will issue reimbursement payments to Grantee on a monthly basis for reported actual cash disbursements that are supported by adequate documentation. Invoice approval and payment is contingent upon receipt of adequate supporting documentation and submittal of acceptable supporting documentation by electronic mail to xxxxxxxx@xxxx.xxxxx.xxx and XXXXxxxxxxx@xxxx.xxxxx.xxx, with a copy to the assigned System Agency Contract Representative identified in the Signature Document. At a minimum, every invoice should include:
1. Grantee name, address, email address, vendor identification number, and telephone number;
2. DSHS Contract or Purchase Order number;
3. Identification of service(s) provided;
4. The total invoice amount; and
5. Any additional supporting documentation that is required by this Statement of Work or as requested by System Agency.
B. System Agency will pay Grantee monthly on a cost reimbursement basis and in accordance with Attachment B, Project FY2025 Budget, of this Grant Agreement. System Agency will reimburse Grantee only for allowable and reported expenses incurred within the Project FY.
C. Grantee may request a one-time working capital advance not to exceed twelve percent (12%) of the total funds allotted per Project FY. All advances must be expended by the end of the Project FY. Advances not expended by the end of the Grant Agreement term must be refunded to System Agency. System Agency may require Grantee to repay all or part of advance funds at any time during the Grant Agreement term. However, if the advance has not been repaid prior to the last three (3) months of the Grant Agreement term, the Grantee must deduct at least one-third (1/3rd) of the remaining advance from each of the last three (3) months’ reimbursement requests. If the advance is not repaid prior to the last three (3) months of the Grant Agreement term, System Agency will reduce the reimbursement request by one-third (1/3rd) of the remaining balance of the advance.
INVOICE AND PAYMENT. A. Grantee shall request payment by preparing an invoice and submitting acceptable supporting documentation for reimbursement of the required services/deliverables. Invoices and supporting documentation provided shall be submitted to System Agency no later than thirty (30) days after the last day of each month. Documentation shall be submitted in a format approved by DSHS Immunization Unit.
1. Grantee name, address, email address, vendor identification number or Social Security number, and telephone number;
2. DSHS Contract or Purchase Order number;
3. Dates services were completed and/or products were delivered; and
4. The total invoice amount; and
5. Supporting documentation must include receipts with a zero balance for items such as hotel, rental car and fuel, taxi, airline or mileage as documented by a readily available online mapping service. Receipts for supplies, registration fees and other items ordered and paid. A copy of the Personnel and Temporary Staff General Xxxxxx for the period which supports the budget items requesting reimbursement. Paid invoices to contractors for services received. Receipts for meals are not required.
B. Grantee shall request monthly payments using the State of Texas Purchase Voucher (Form B-13) at xxxx://xxx.xxxx.xxxxx.xxx/grants/forms.shtm. Voucher and supporting documentation shall be mailed or submitted by fax or electronic mail to DSHS Claims Processing Unit at the address/number below, and also sent via email to Xxxx Xxxxxxxxxxx, DSHS Contract Management Section, at Xxxx.Xxxxxxxxxxx@xxxx.xxxxx.xxx, and to the Immunization Unit at XXXXXxxxxxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. Department of State Health Services Claims Processing Unit, MC 1940 0000 Xxxx 00xx Xxxxxx P.O. Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx and to XXXxxxxxxxx@xxxx.xxxxx.xxx
X. Xxxxxxx will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B of this Contract. Budget Categories Budget for FY 2019
INVOICE AND PAYMENT. 1. Payments are on a monthly cost-reimbursement basis in response to an invoice and purchase voucher.
2. Grantee will submit an invoice and purchase voucher monthly, no later than the last day of the month following that in which the expenditure occurred. If the last day falls on a weekend or holiday, the documents are due the next business day.
3. Grantee shall submit a final close-out invoice annually, not later than 45 calendar days following the end of the fiscal year. Reimbursement requests received more than 45 calendar days following the termination of the Grant may not be paid. CONTRACT (GRANT) NUMBER: HHS000791900001 AGENCY ID: 24814021
4. PEI will pay Grantee from available funds for services rendered in accordance with the terms of this Grant Agreement upon receipt of a proper and verified invoice and after deduction of any known previous overpayment made by DFPS.
