Informal Caregiver Invoice - ltcfeds.com - Federal Long Term Care ... 2026

1. Click ‘Get Form’ to open the Informal Caregiver Invoice in the editor.
2. Begin by entering the insured’s claim ID and name, along with the informal caregiver’s name. This information is crucial for processing your invoice.
3. For each date of service, enter one date per line. Ensure you complete the time in and time out fields, indicating a.m. or p.m., rounding to the nearest quarter hour.
4. Fill in the total hours worked, approved hourly charge as per your plan of care, and calculate the daily total for each service date.
5. Enter the total reimbursement amount requested at the end of your entries.
6. Mark an ‘X’ in the appropriate box for each activity of daily living service provided. Be sure to follow definitions provided for clarity.
7. Input check or transaction numbers corresponding to each date of service and attach required proof of payment as outlined in the instructions.
8. Ensure both the informal caregiver and insured (or their legal representative) sign and date the invoice after services are rendered.

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