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Maternal, Child and Adolescent Health Division

Budget and Invoice Templates​​

For agencies that invoice monthly, invoices must be received within 30 days of the invoice period.
(Ex. Month: March - due April 30, 2022).

​Invoice Submissions

All invoices and supporting documentation must be su​​bmitted via email to the MCAH invoice inbox: To ensure appropriate processing, please use the following invoice naming protocol for the signed invoice PDF and Excel files as well as the subject line of the email:

Agreement Number, Agency Name, Fiscal Year, and Invoice Quarter (or Month) and Number -

Example: 202201​​​, Alameda, FY 22-23, Q1 (or M1).

Invoice submission​​ must include:

  • signed cover letter noting invoice amount, invoice period, remit to address, and any personnel changes

  • signed invoice

  • excel version of invoice

  • signed and completed Title XIX cover sheet (if applicable)

  • signed and completed attestation form (PDF)​ (if applicable)

  • Title V and Title XIX time s​tudies (if applicable)

Invoice Deadlines

​Quarter 1 (July - September 30) ​​November 15th
​Quarter 2 (October - December 30) ​February 15th
​Quarter 3 (January - March 30) ​May 15th
​Quarter 4 (April - June 30) ​August 15th
​Approved Supplemental Invoice
​September 30th​​​


(916) 650-0275

For further question or concerns, please contact the contract liaison assigned to your agreement.

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