STATE OF CALIFORNIA DEPARTMENT OF REHABILITATION
SUPPORTED EMPLOYMENT – INDIVIDUAL – INVOICE SUMMARY
DR385A (Rev. 03/20)
(SE Service Provider Name & Address)
DOR District Office Name & Address:
Department of Rehabilitation
Month/Year:
INSTRUCTIONS:
• Individual Placement (IP) SE Services must be documented by the following:
o Intake - attach the first DR382 - SE - Placement Services Progress Report.
o Placement - attach the DR383 - SE - Job Placement Information.
o Retention - attach the third DR384 - SE - Monthly Job Coach Report.
o Individual Job Coach Hours - attach (1) DR385B detail sheets and (2) page 2 of
the DR384. Hours invoiced cannot exceed the authorized hours. If the hours on the
DR384 exceed the authorized amount, only the authorized amount can be billed.
• Submit an original signed in blue ink and one (1) copy.
• Write "Individual Supported Employment Invoice" on the envelope.
• Mail to the DOR District Office, Attention: SEP Invoice Coordinator.
For each of the services invoiced, I understand that payment from DOR is payment in full for the services provided,
pursuant to Title 9 CCR Section 7322. I certify that I am authorized to make such certification for the above-named
rehabilitation facility that (1) no duplicate payment or other funding has been received or is anticipated from any source for
the same consumer, service and service period; and (2) the services invoiced have been provided.
Signature (use blue ink):
Completed by (type or print):
Email:
DOR USE ONLY: Approved for payment based
on documentation of services provided.
Distribution: DOR District Office Service Provider
Attachments: DR385B DR382 DR383 DR384
NOTICE: This is confidential information from the records of the California Department of Rehabilitation. State law and departmental
regulations prohibit you from making any further disclosure of this information without the informed, written consent of the person to
whom this information pertains.
