Get Natural Resources Service Center Video Display Terminal ... - Maine.gov - Maine

Filling out the Natural Resources Service Center Video Display Terminal Operator Eye Exam form is essential for eligible employees seeking reimbursement for vision-related expenses. This guide provides clear, step-by-step instructions to assist users in completing the form accurately.

Follow the steps to successfully complete the reimbursement form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In section A, the employee should provide their name, job title, agency, and mailing address. They need to affirm their eligibility for reimbursement by indicating their usage of video display terminals and sign and date the section.
3. In section B, the supervisor must confirm that the employee meets the required criteria of spending at least 80% of their time operating video display terminals. The supervisor should complete the payment codes for reimbursement and sign with the date.
4. In section C, the employee needs to specify the reimbursement details for both exams and lenses, including insurance co-pays, total reimbursement amounts for themselves or the vendor, and provide necessary vendor details if applicable.
5. Employees should attach the original bills and receipts, as well as the Certificate Authorizing Release of Information and the eye exam report completed by a doctor.
6. Finally, review all entries for accuracy, then save any changes, and download, print, or share the completed form as required.

Complete your documents online to ensure timely processing of your reimbursement requests.