Download Direct Payment Quarter 1 Return Sheet for Financial Year 2014/2015

Direct Payment Quarter 1 Return Sheet for Financial Year 2014/2015
Service User’s First Name …………………………………..
Service User’s Surname …………………………………..
Service User’s Address …………………………………………………………………………………………………………...
DIRECT PAYMENTS QUARTERLY RETURN 1
B
1
31-Mar-14
2
07-Apr-14
3
14-Apr-14
4
21-Apr-14
5
28-Apr-14
6
05-May-14
7
12-May-14
8
19-May-14
9
26-May-14
10
02-Jun-14
11
09-Jun-14
12
16-Jun-14
13
23-Jun-14
G
PAYMENTS RECEIVED
H
Balance From Previous Quarter
EXPENDITURE INCURRED
E
F
INVOICES/RECEIPTS
ATTACHED
NOTES
April
WEEK COMMENCING
D
May
WEEK
C
June
A
Total In
I
Total Out
J
Balance at End of Quarter
If Original Bank Statements to be Returned
Please Tick Box:
TICK:
The information stated above is an accurate record of expenditure which I have incurred in relation to my agreed package for the above weeks.
Signed: ………………………………………..
ECC11210
Page 1 of 4
Date: ………………………………………..