Forms and Invoices
Capacity Building
Package and Invoices:- LPHA Bonus Payment Invoice Submission Form (1-A and 1-B)
- Instructions for Workforce Sustainability Plan Monitoring Report (1-C & 1-D)
- Workforce Sustainability Plan Monitoring Report Template (1-C & 1-D)
- Counselor Training (1-E) and Certification (1-F) Expenditure Cover Sheet (Updated - April 2025)
- Counselor Training (1-E) and Certification (1-F) Workbook
- Sample Expenditure and Certification 1E and 1F Workbook
- Sample Counselor Training and Certification Expenditure Cover Sheet
- Workforce Development Expedited Training (1-E) & Certification (1-F) - Verification Submission Overview Process
- Instructions for MAT Prescribing Clinician Start Up Cost Sharing (1-G)
- Implementation Plan MAT Prescribing Clinician Start Up Cost Sharing non-OTP (1-G)
- Implementation MAT Prescribing Clinician Start Up Cost Sharing non-OTP-Addendum (1-G)
- Implementation Plan MAT Prescribing Clinician Start Up Cost Sharing OTP Only (1-G)
- Implementation for MAT Prescribing Clinician Start Up Cost Sharing OTP Only-Addendum (1-G)
- Instructions for Completing MAT Quarterly Progress Report (1-H) (Revised - March 2025)
- Language Assistance Needs Assessment Prompts (pdf) (1-I)
- Language Assistance Plan Template (1-I)
- Guidance for Developing the Language Assistance Plan Final (1-I)
- Language Assistance Plan Toolkit (1-I)
- Language Assistance Plan Implementation Report (1-I)
- Language Assistance Plan and Implementation Report Frequently Asked Questions (FAQs)(1-I)
- Quarterly Bilingual Bonus Invoice & Submission Form (1-J)
- Bilingual Bonus Orientation Training Slides Informational Purposes Only (1-J)
- Scheduling Staff Language Assessment with TransPerfect Informational Purposes Only (1-J)
- SAPC Bilingual Bonus Invoice Submission Guide (1-J)
- Bilingual Differential Supplemental Form (1-J) - For use only if agency provides differential pay.
- Admission Policy Required Language (2-A) (pdf)
- Admission Policy Required Language (2-A)
- Discharge Policy (2-B) (pdf)
- Discharge Policy (2-B)
- Admission/Discharge Policy Training Presentation Required Language (2-C) (pdf)
- Admission/Discharge Policy Training Presentation Required Language (2-C)
- Admission Agreement for Patient Signature Required Language (2-D) (pdf)
- Admission Agreement for Patient Signature Required Language (2-D)
- Toxicology Policy and Patient Agreement Required Language (2-E) (pdf)
- Toxicology Policy and Patient Agreement Required Language (2-E)
- Staff Training Deliverable A (2-F)
- Staff Training Deliverable B (2-F)
- Change Project Plan (2-G)
- Customer Walk-Through Guidance and Deliverable Templates (2-H) (PDF)
- Implementation/Investment Plan Template (2-I) (PDF)
- Treatment Agency Staff Participation In Harm Reduction Trainings – Attestation And Verification (2-J)
