Get Ac 3253 S Form

The AC 3253 S Form is essential for agencies seeking reimbursement for training expenses related to New York State BEMS Certification Courses. This guide provides a step-by-step approach to help users accurately complete this form online.

Follow the steps to successfully fill out the AC 3253 S Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Enter your agency code, which is a 4-digit identifier assigned by BEMS.
3. Fill in your agency's name in the Vendor Name field.
4. Provide the official mailing address of your agency, including the city, state, and zip code.
5. Input your agency's vendor identification number assigned by the Office of the State Comptroller.
6. Include an invoice number that corresponds with this voucher.
7. Select the course level completed by the certified providers (Original, Refresher, or CME) by checking the appropriate box.
8. Enter the course number attended by the certified provider in the Course Number field.
9. Input the certification number for each certified provider you are submitting for reimbursement.
10. List the names of certified providers on the form as required.
11. Indicate the total number of certified providers included in your submission.
12. Ensure that the reimbursement rate corresponding to the course level is entered accurately.
13. Verify that the amount for reimbursement calculations accurately reflects the requested total.
14. Leave the Discount % field blank, as it is not applicable.
15. Review the automatically calculated fields, including Total and Net, for accuracy.
16. Print the form and include an ink signature in the Vendor’s Signature field once completed.
17. Enter the title of the person signing the voucher in the Title field.
18. Fill in the date of signature in the Date field.
19. Leave the Name of Company field blank.
20. After all fields are filled and verified, save your changes. You may then download, print, or share the form as needed.

Complete your AC 3253 S Form online today to ensure timely reimbursement for training expenses.