MISSOURI DEPARTMENT OF SOCIAL SERVICES CHILDREN'S DIVISION Intensive In-Home Services/Intensive Family Reunification Services – Vendor Invoice
Vendor Name, City, State, And Zip Code	Invoice Number	Invoice Date
Vendor Number	Contract Number	Site Number
IIS/IFSR Specialist's Name	Month Year	Dates of Availability	Units	Rate	Total
01	02	03	04	05	06	07	08	09	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24	25	26	27	28	29	30	31
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Subtotal ►	0	$0.00
Part-Time IIS/IFSR Specialist’s Name
$0.00
$0.00
$0.00
Key For Dates Of Availability (X) Specialist Hired, Trained And Available (S) Equally Trained And Available Substitute For Specialist ( ) Specialist Or Substitute Not Available	Subtotal►	0	$0.00
Total►	$0.00
CD Payment Designee	Title	Date	Vendor Signature	Title	Date