Get F245 145 000

The F245 145 000 form is a travel reimbursement request primarily used for expenses related to worker's compensation claims. Filling it out correctly is essential to ensure timely processing of your reimbursement.

Follow the steps to successfully complete the F245 145 000 form online.

1. Click ‘Get Form’ button to obtain the form and open it in your browser.
2. Begin by filling in your worker information, including your claim number, full name (last, first, middle initial), date of injury, home address (not PO Box), apartment number, city, state, social security number (for identification purposes), and ZIP code. Ensure all information is accurate and printed clearly.
3. Provide your phone number for contact purposes and select the reason for travel by checking one of the available options: medical visit or treatment, vocational services, or attending retraining class. If attending a retraining class, ensure to attach a copy of the Transportation Encumbrance form (F245-375-000) signed by your vocational counselor.
4. In the travel information section, complete each column accordingly: Column A for the date of travel (one date per line), Column B for the travel code (only one code per line), Column C for the city you traveled from, Column D for the city you traveled to, Column E for the provider's name and reason for visit, Column F for the number of miles traveled round trip, and Column G for the dollar amount of each relevant expense.
5. Ensure that each expense has corresponding receipts attached, as required. For parking expenses under $10, receipts are not necessary. Make sure all receipts are itemized and legible.
6. In the signatures section, obtain the required signatures: the provider or office staff signature to verify your appointments, and your own signature confirming that the expenses are related to your worker's compensation claim, along with the understanding of the legal implications of providing false information.
7. Review the completed form for accuracy. Once finished, you can save changes, print, and share the form as needed before submission.

Complete your forms online today and ensure a smooth reimbursement process.