Get Tx E-khc-3 2015-2025

The TX E-KHC-3 form is essential for individuals seeking reimbursement for travel expenses related to home dialysis and kidney transplant services. This guide provides a step-by-step approach to filling out the form accurately and efficiently, ensuring that users can navigate the process with ease.

Follow the steps to complete the TX E-KHC-3 form online.

1. Click ‘Get Form’ button to obtain the form and open it in an editable format.
2. Begin by filling in your personal details in section one. Include your last name, first name, middle initial, phone number, social security number (optional), and KHC number.
3. Proceed to section two where you must provide details of your travel. Complete all four columns in the provided table that includes the date of the trip, name of the person or place visited, full location address, and reason for the trip.
4. For the reason for your trip, choose a code from the list provided, or check 'Other' if applicable and provide further details on the back of the form.
5. In section three, sign the form to affirm that the trips listed were solely for the purposes indicated and that no other agency will reimburse you for these trips.
6. If you checked 'Other' in section two, complete the additional information required on the second page. This includes trip dates, places visited, and how each trip is related to end-stage renal disease or kidney transplant.
7. Once all sections are filled out accurately, you may save your changes, download the completed form, print it, or share it as needed.

Complete your TX E-KHC-3 form online today for prompt reimbursement of your travel expenses.