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Get Google 600 145000 7 Form
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How to fill out the Google 600 145000 7 Form online
This guide provides clear instructions on completing the Google 600 145000 7 Form online. By following these steps, users with various levels of experience can efficiently and accurately submit their travel reimbursement requests.
Follow the steps to complete the Google 600 145000 7 Form online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In the 'Injured Worker Information' section, enter your name, date of injury, home address (not P.O. Box), social security number, city, state, and ZIP code. Ensure that all information is accurate.
- In the 'Travel Information' section, check the box corresponding to the reason for your travel. If you select more than one reason, use a separate form for each travel type.
- Column A requires the date of each trip or expense, ensuring to write one date per line.
- Column B needs the expense code which relates to the type of travel. Reference the provided chart to select the correct code.
- Column C involves entering the city where you resided on the travel date.
- Column D should state the city you visited during your travel.
- In Column E, write the name of the person you saw and the purpose of your visit. This could include terms like examination, physical therapy, or vocational services.
- Column F requests that you list the total round trip mileage traveled.
- Column G (optional): If desired, calculate and list the total mileage cost based on the department's mileage rate on the date of travel.
- Column H requires you to specify the dollar amount for each individual expense related to travel. Make sure to attach receipts for each expense.
- Ensure all required signatures are obtained: the medical provider for medical visits, the vocational counselor for vocational services, and your signature confirming the accuracy of the information.
- After completing the form, save your changes. You can download, print, or share the final document as needed.
Complete your documents online to ensure a smooth processing of your travel reimbursement request.
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