Features

 
Contact Information
Los Angeles County
Department of Public Health
Office of Women's Health
1000 S. Fremont Ave.
Building A-9 East, Unit #105
Alhambra, CA 91803
Phone: (626) 293-2600
Email: owh@ph.lacounty.gov
DVHSS header

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 07/2021
OWH_Form03 OWH Financial Closeout Report 01/2021
DOMESTIC VIOLENCE SHELTER (DVSBP)
Forms exclusively used for DVSBP Contractors
DVSB_Form01 DVSBP Invoice 09/2021
DVSB_Form02 DVSBP Annual Report 03/2022
DVSB_Form04 DVSBP Budget Form 07/2020
DVSB_Form05 DVSBP Budget Modification Form 07/2020
DVSB_Form06
DVSB_Form06.1
DVSBP Customer Service Questionnaire English
DVSBP Customer Service Questionnaire Spanish
07/2020
04/2021
DOMESTIC VIOLENCE SUPPORT SERVICES (DVSS)
Forms exclusively used for DVSS Contractors
DVSS_Form01 DVSS Case Management Invoice 06/2021
DVSS_Form02 DVSS Legal Services Invoice 06/2021
DVSS_Form03
DVSS_Form03.1
DVSS Supplemental Invoice - Case Management
DVSS Supplemental Invoice - Legal Services
06/2021
06/2021
DVSS_Form04 DVSS MMR - Case Management 09/2020
DVSS_Form05 DVSS MMR -  Legal 09/2020
DVSS_Form06 DVSS Event Services/Outreach 07/2020
DVSS_Form07
DVSS_Form07.1
DVSS Customer Service Questionnaire English
DVSS Customer Service Questionnaire Spanish
07/2019
04/2021
DVSS_Form08 DVSS Budget Form 11/2021
DVSS_Form09 DVSS Budget Modification Form 11/2021
DVSS_Form10 DVSS Financial Closeout Report 07/2022 

 


 
Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.
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