Get In Form 28808 2017-2025

Filling out the IN Form 28808, which is a claim for support of children, can seem daunting. This guide aims to simplify the process by providing clear, step-by-step instructions for completing the form online.

Follow the steps to fill out the IN Form 28808 efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section 1, enter the legal name of the vendor, ensuring it matches the name submitted via the Vendor Information Form.
3. For Section 2, provide the last four digits of the Tax Identification Number or Social Security Number associated with the legal name.
4. Fill in Section 3 with the State Vendor ID number, which can be found through the appropriate resources.
5. Assign a unique invoice number in Section 4, making sure it's no longer than 8 characters.
6. Record the date of the invoice in Section 5. This date must be when the claim is assigned and needs to be submitted within 10 business days.
7. Enter the complete address of the vendor in Section 6, matching the most recent records.
8. Indicate the type of invoice in Section 7. Choose from options like first bill, rate adjustment, re-bill, or appeal.
9. Specify the current page number and total pages in Section 8.
10. In Section 9, select the invoice service type that accurately reflects the services provided.
11. For Section 10, specify the billing period, indicating the start and end dates for the claimed services.
12. Calculate and enter the total claim amount in Section 11, ensuring it represents the cumulative costs correctly.
13. In Section 12, write the name of the county receiving services for the child.
14. Complete Section 13 with the billable unit referral ID and Section 14 with the case ID.
15. In Section 15, provide any necessary comments or documentation, including the NPI number if applicable.
16. List the billing code in Section 16 by referencing the necessary resources.
17. Record the beginning date of service in Section 17 and the end date in Section 18.
18. Specify the number of units for services rendered in Section 19.
19. Enter the rate per unit in Section 20, calculated to two decimal places.
20. Calculate the total cost in Section 21 by multiplying the number of units by the rate.
21. Sign the document in Section 22, providing your authorization.
22. Include your telephone number and email address in Sections 23 and 24, respectively.
23. Finally, enter the date the invoice was completed in Section 25, ensuring it is not before the last day of service.

Complete and submit the IN Form 28808 online with confidence today!