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SECTION 800 PROGRAM REPORTING

LIHEAP MANUAL JANUARY 2022 38

801.14 MONTHLY RMRP INVOICE (Cont’d)

Agency Identification and financial information (must manually enter appropriate information)

• Contractor Agency No. and name • OHS Contract No. • Contractor Expenditure /Account# • Electronic Funds Transfer • Remittance Address (if check) Type of Expense and Fund Source

• Regular • Revised • Final • Fund Source • Number of Approvals with client list • Number of Denials • Total number referrals x contract rate for each referral • Total dollar amount requested

Certification Statement and Signature Section (must manually enter appropriate information)

• Report Preparer • Authorized Representative Name Title • Date • Telephone No.

OHS Approval Section

• Approving Authority • Name/Title • Date Approved