LA County Department of Public Health

Invoices, Forms and Report Templates

Please note that for invoices, you must submit an e-signature. For instructions, please click here

Form Name	Form	Last released
DVHSS GENERAL DOCUMENTS Forms used by all contractors, regardless of contract
OWH_Form01	OWH Contract Contact Signature Authorization Form	08/2023
OWH_Form03	OWH Financial Closeout Report	01/2021
DOMESTIC VIOLENCE SHELTER (DVSBP) Forms exclusively used for DVSBP Contractors
DVSB_Form01	DVSBP Invoice	02/2023
DVSB_Form02	DVSBP Annual Report	03/2022
DVSB_Form04	DVSBP Budget Form	05/2020
DVSB_Form05	DVSBP Budget Modification Form	05/2020
DVSB_Form06 DVSB_Form06.1	DVSBP Customer Service Questionnaire English DVSBP Customer Service Questionnaire Spanish	05/2020 04/2021
DOMESTIC VIOLENCE SUPPORT SERVICES (DVSS) Forms exclusively used for DVSS Contractors
DVSS_Form01	DVSS Case Management Invoice	10/2023
DVSS_Form02	DVSS Legal Services Invoice	07/2023
DVSS_Form03 DVSS_Form03.1	DVSS Supplemental Invoice - Case Management DVSS Supplemental Invoice - Legal Services	10/2023 07/2023
DVSS_Form04	DVSS MMR - Case Management	07/2023
DVSS_Form05	DVSS MMR - Legal	07/2023
DVSS_Form06	DVSS Event Services/Outreach	05/2020
DVSS_Form07 DVSS_Form07.1	DVSS Customer Service Questionnaire English DVSS Customer Service Questionnaire Spanish	05/2019 04/2021
DVSS_Form08	DVSS Budget Form	11/2021
DVSS_Form09	DVSS Budget Modification Form	10/2022
DVSS_Form10	DVSS Financial Closeout Report	01/2024

Features