Follow the steps to complete the Cir Reimbursement form online.

1. Press the ‘Get Form’ button to access the Reimbursement form and open it for editing.
2. In Section A, enter your participant's name, including both last and first names. Fill in your Social Security number, home address, and contact phone number, specifying the type of phone. Provide your email address, the hospital where you are employed, your PGY level, and your department.
3. Indicate your role by checking the appropriate box: Final Year, Chief Resident, or Fellow. Then, fill in the title of the conference, the GME credits if applicable, the date of the conference (from and to), and the location of the conference including the facility name, city, and state.
4. Proceed to Section B and check the appropriate documents you are attaching: registration receipt, program/agenda, proof of attendance, and identification badge.
5. List the amounts for each type of expense for which you are providing receipts, such as registration/tuition, lodging, meals, travel, tolls, gas, telephone, and any other specify. Include the total amount of the receipts and determine your maximum reimbursement based on the eligibility criteria.
6. Answer whether you have submitted for conference reimbursement during your current PGY year. If yes, provide the date you submitted and the amount.
7. Sign the form as the resident and include the date of your signature. Also, have the Chairperson review the form, providing their name and signature along with the date and department.
8. Once all sections are completed, save the changes, and consider downloading or printing the form for your records. Ensure that all original receipts are attached before submission.

Complete your Cir Reimbursement form online today and ensure all necessary documents are submitted for a smooth reimbursement process.