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wpainvoices@montgomerycountymd.gov

Provider Invoice Form

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The voucher end-date is subject to available funding and the parent continuing to meet WPA eligibility requirements. Parent and provider will be notified of changes affecting enrollment and modifying the period of authorization.

You will receive payment within fifteen (15) business days of the date the invoice is received.

For large Center providers with multiple locations - we advise that you submit vouchers per location to ensure correct payment.

For easy completion - you should have the WPA voucher on hand - as information from the program voucher is required to complete the invoice.

*You can submit for only 20 children per invoice form

Provider Information

General Information

Provider Type

Provider Address

Provider Contact Name


Provider Fiscal Information

Invoice Month/Year

Date Picker

Child(ren) Information

Child 1 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 2 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 3 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 4 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 5 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)

Child 6 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 7 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 8 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 9 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 10 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)

Child 11 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 12 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 13 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 14 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 15 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)

Child 16 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 17 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)

Child 18 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 19 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)


Child 20 - Information - (Refer to your WPA Voucher for - the Child WPA ID, WPA Voucher ID, Monthly WPA Subsidy Rate, and Provider Site information)

Provider Consent, Confirmation, and Signature

Invoice Number

You will be provided with a Invoice Number upon submission.

I verify that the information I have provided on this invoice, and all information submitted in support of this invoice is true, correct and complete. I understand that my invoice request can be denied payment if the provider is making false or incorrect statements or failing to report changes.

I swear (or affirm) that all information on this invoice is true, correct and complete to the best of my ability, knowledge and belief.

I understand that I should receive payment within fifteen (15) business days of the date the invoice is received by the Working Parents Assistance (WPA) Program. I hereby give DHHS permission to contact me by telephone, text, or email.

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NOTE: After you click on Submit - keep the receipt numbers for your records. You will be given the option of downloading a PDF version of your invoice - please download as you cannot access this application after submittal.