Get Ny Ac3253-s 2012

The NY AC3253-S form is a crucial document for agencies seeking reimbursement for training certifications within New York State. This guide will provide clear and straightforward instructions to help you fill out the form accurately and efficiently, ensuring your submissions are processed without delay.

Follow the steps to complete the NY AC3253-S form online.

1. Click the ‘Get Form’ button to obtain the NY AC3253-S form and open it in your preferred PDF editor.
2. Enter your BEMS 4-digit agency code in the designated field. This code identifies your specific agency.
3. Fill in the vendor name field with your agency's official name as recognized by the state.
4. Provide your agency's official mailing address, including the city, state, and zip code.
5. Input your vendor identification number as assigned by the Office of the State Comptroller. If you don't have a vendor ID, refer to the designated vendor support resources.
6. Leave the invoice number field blank, as instructed.
7. Select the course level of the certified provider(s) by checking the appropriate box, noting that only one box may be selected.
8. Specify the course number associated with the certification. If it’s for CME recertification, no course number is required.
9. Indicate the certified provider’s BEMS certification number in the provided section.
10. List the name of each certified provider for whom you are requesting reimbursement.
11. Count the total number of certified providers being listed on this voucher and input it in the respective field.
12. Select the reimbursement rate corresponding to the course level and enter it in the corresponding field, ensuring it aligns with the current rates specified in policy.
13. The amount and total fields will automatically calculate; review to ensure accuracy.
14. Leave the discount percentage field blank.
15. The net amount will also automatically calculate; verify that it reflects your entries accurately.
16. After filling out all sections, ensure signatures are provided in ink once the form is printed.
17. Complete the title of the person who signed the voucher and date the signature appropriately.
18. Finally, save your changes, download, print, or share the completed form as needed.

Complete your NY AC3253-S form online for efficient processing and to secure your training reimbursements.