TX HHS Form 4103. Vendor Invoice Summary

The TX HHS Form 4103, Vendor Invoice Summary, helps vendors summarize their invoices for submission to the Texas Health and Human Services (HHS). This form is typically used by vendors who need to provide a summary of their invoices to HHS. The vendor fills out the form with required information such as invoice date, number, and gross amount.

The key features of this form include the requirement for vendors to use a separate form for each invoice, and not to combine invoices when completing the form. Vendors must also provide their name, vendor ID (TIN or EIN), and purchase order (PO) or contract information. The form instructs vendors to return it with their invoice to [email protected].

Here are some key points to keep in mind when using the TX HHS Form 4103:

• Use a separate form for each invoice
• Do not combine invoices when completing the form
• Return the completed form with your invoice to [email protected]