Instructions for Independent Living Centers to prepare and submit the AC 92 NYS Standard Voucher

To request payment for services provided, a hard copy of the AC 92 standard voucher must be provided. It is not acceptable to fax or email the voucher. The ACCES-VR Contract Unit requires a voucher with an original signature to process the voucher. A center can submit either the form with attached carbon copies or an electronic copy printed from the Internet.

Voucher forms with attached carbon copies can be obtained from the ACCES-VR Contract Unit. The telephone number at ACCES-VR Central Office is 518-486-6585.

Electronic copies of the voucher form in either a PDF format or a fillable MS Word template are available online at the ACCES-VR website in the ILC Toolbox under Contract Development.

The PDF version can be printed and filled in manually. The fillable Word template can be completed electronically, saved, and printed.

When completing the fillable Word template, it will be necessary to temporarily remove comments embedded in the right margin of the document. The content of the completed voucher form can be saved, but the deleted comments will appear each time the document is opened. To remove the comments: first click Review at the top of the toolbar; next click Show Markup; next click Reviewers; last click All Reviewers.

All contract vouchers for payment (with original signatures) are to be mailed to:

Dennis Barlow
Independent Living Services Unit
NYSED Building Annex, Room 580
89 Washington Avenue
Albany, New York 12234

Electronic copies of the voucher are also available online at the NYS Office of State Comptroller website. On the page Forms for State Agencies and Employees scroll down to the section Purchasing and Payments that includes the AC-92 Standard Voucher in both a Word template and a PDF format.