FDR VoC / PFM Outcome Form FDR VoC / PFM Outcome VoC / PFM Panelist:* First Last Panelist's Email* FDR Centre Case Number and Name:* Did the parties engage in Voice of the Child or PFM?* Voice of the Child PFM Have you contacted the FDR provider to confirm outcome/hours of the VoC / PFM session? Yes No Date of VoC/PFM session*If sessions were held on multiple days, please enter the date of the first session. DD slash MM slash YYYY Time of VoC / PFM session*Time of the first session : Hours Minutes AM PM How many hours of VoC / PFM services were provided to the parties?*Please provide this to the closest 15 minutes. : Hours Minutes How was the VoC / PFM undertaken?* In person Telephone Videoconference (eg Skype) Select as many options as are relevant.Location of in-person meetingPlease provide the name of the city / town in which VoC or PFM was conducted Please enter the parties name who you met with TravelDo you wish to claim travel for the VoC / PFM?*Only answer "yes" if you wish to claim your travel time as a disbursement. Please note that you can only claim the travel time from your work address to the session location where the travel distance is over 50km. Please note the Ministry of Justice’s prior approval is required for any travel expenses and room hire which will in total exceed $575 (including GST) per event. Yes No How many hours travel time are you claiming?*To the nearest 15 minutes. : Hours Minutes How many kilometres did you travel?* Work Address* Street Address Address Line 2 City Address of VoC / PFM* Street Address Address Line 2 City If you are claiming travel time as a disbursement for multiple days and/or locations, please explain below.Please ensure you include the travel cost as a disbursement in your invoice.Room HireageDo you wish to claim room hireage as a disbursement?*Room hireage can be claimed up to a maximum of $230 (including GST) per day pro-rated, ie if room is required for a half-day, funding will be limited to $115 (including GST). Yes No Please indicate the amount you are claiming for room hireage excluding GST Please ensure you include the room hireage charge as a disbursement in your invoice.Invoice and payment for VoC / PFM MediationFor payment of your fee for VoC / PFM services, please provide us with a tax invoice by uploading it below. Your invoice should be based on an hourly rate of $160.00 including GST.If you wish to claim travel or room hireage as a disbursement, please ensure this is included in your invoice as well. Drop files here or Select files Max. file size: 64 MB. Final CommentsIs there anything further that your case manager should know at this time?