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Low Income Home Energy Assistance Program Division 10 Service 415 Program 415 Chapters 05 - 65 North Dakota Department of Health and Human Services

"Request for Payment" Printout 415-35-10-05 (Revised 12/1/03 ML #2895) View Archives

The following is a very general statement of the billing process. For details and to answer specific questions from vendors, refer to the "Billing Instructions" section of the Vendor's Billing Manual Chapter 416-01.

1. Information Given on the Report In the upper left-hand corner will be printed the vendor's name, address, telephone number, and the vendor identification number. The vendor ID number is a seven-digit number.

At the top center of the report is given the name of the report and the date on which the report was printed.

In the upper right-hand corner will be printed the instructions to the vendor for completing the billing section.

The information for each customer is listed in alphabetical order of the customer's last name. It includes the name and billing number of the customer. If the customer account number was included on the "Household Data" screen, it will be included on the report. (Customer account numbers for MDU, Xcel Energy, Ottertail, and Ferrellgas are submitted on their web billing.) The customer's co-payment percentage, the LIHEAP benefit percentage, and the authorization period are given on the report. 2. Completing the Billing Section To the right of the customer's billing number are blanks for the vendor to use to write in the amount of unpaid bills. The vendor MUST complete the date of delivery, write in the code for the type of fuel provided, the amount of product (gallons, KWH, etc.) and enter