DYFS Form K-100 - nj 2025

1. Click ‘Get Form’ to open the DYFS Form K-100 in our editor.
2. Begin by filling in the Local Office of Charge in box [1], ensuring you enter the official name as provided by your caseworker.
3. In box [3], input the Office Mailing Address where the invoice should be sent for processing.
4. Complete the Resource Name and ID in boxes [4] and [5]. Make sure these match your contract details.
5. For each line item, provide details such as Participant Name, ID, and a brief Service Summary in boxes [14], [15], and [16].
6. Indicate whether services were court ordered in box [17A] and provide the Court Order Date if applicable.
7. Fill out payment details including Payment From/To dates, Unit Type, Unit Rate, and calculate Line Item Total Amount in boxes [18] to [23].
8. Finally, ensure all required signatures are obtained before submitting the completed form to your local office.

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