Get Claim Voucher

Filling out the Claim Voucher online can streamline the process of submitting claims to the relevant agency. This guide provides you with clear, detailed instructions to ensure that your submission is accurate and complete.

Follow the steps to complete the Claim Voucher effectively.

1. Click 'Get Form' button to access the Claim Voucher and open it in your preferred online editor.
2. Begin by entering the name of the agency personnel who prepared this claim in the designated field labeled 'Name'. This is important for accountability.
3. Provide a contact number in the 'Phone' field. This allows for any necessary follow-up regarding your claim.
4. Next, fill in the date of the submission in the 'Date' field using the format month, day, and year.
5. Enter the document number as assigned by your agency in the corresponding section.
6. Input the agency information including the 'Name of agency', 'Agency Number', and the 'Address' (including number and street).
7. Fill in the vendor information with the 'Name of vendor', their 'Federal I.D. Number', and 'Vendor Number' as applicable.
8. Provide the 'City, State, and ZIP Code' in the required format (00000-0000).
9. In the section for claim details, enter the 'GROSS AMOUNT $' for the claim you are submitting.
10. Lastly, ensure to sign the form as both the authorized representative of the state agency and the vendor, along with the respective dates.
11. Once all fields are completed, you may save changes, download, print, or share the Claim Voucher as needed.

Complete your Claim Voucher online today to ensure a smooth claims process.