Individualized Supports Invoices

Only the person approved to Direct these funds may authorize and submit this form. It is ok if you receive help to complete the form.

*Note- the person authorized to "direct the funds" is specified in the contract with Community Living Windsor. It is usually a family member (but not always). It is NEVER an employee or independent contractor.

Type of Invoice*

Support Hours Mileage Other Reimbursements

Admin Notes

Optional Administrative Notes

Individualized Supports Invoice Submission

Invoice Submission Date*

:

Name of the person receiving support*

First Name

Last Name

Name of the person completing this form (should be the person authorized to Direct funds)*

First Name

Last Name

Enter an email address for confirmation*

Support Hours

Make an entry for only ONE SUPPORT PERSON. You can choose any period of time that is convenient, as long as it's for the same rate.

Eg. You can submit for a day, a week, a month, or any other period of time you want. If the person has multiple rates (eg awake/asleep) you must submit separate forms.

Support Worker's Name*

First Name

Last Name

Start Date*

End Date*

Rate*

Number of hours / units*

Total Support Amount* CA$

Mileage

You can enter mileage for any period you like (a day, a week, or even longer). You do not need to separate mileage by person unless the rates are different.

Please make sure to include a photo of a signed mileage log.

Start Date*

End Date (if applicable)

Rate per km*

Number of km*

Total Mileage Amount* CA$

Other Reimbursements

Please enter only one item at a time. Please do not group a series of receipts.

The reason for this is that some types of items may in eligible/ineligible under certain types of funding and it isn't possible to separate them after submission.

*However: If you have multiple receipts for the same thing, you can enter those together. Eg if you have payments for movie tickets for 3 separate days, you can total them together and upload all 3 receipts together.

Description of Item to be Reimbursed*

Start Date*

End Date (if applicable / you have more than 1 invoice)

Total Amount* CA$

File Uploads

To upload attachments you can either attach a document or, if you're using a smartphone, you can take a picture. Every submission must include at least one attachment. Depending on your circumstances, this could be receipts, signed mileage logs, signed hours/wage logs, etc. You must upload at least one attachment and you can upload as many as five.

Tip: If taking a picture, please make sure that the quality is good and that it's close enough to the document that the details are clear.

Please take a good photo or upload your Invoice / Receipts #1*

No File Chosen