The Pennsylvania Special Reimbursement Form is used to request reimbursement for additional costs incurred by eligible entities in providing services to students with disabilities. The form is used to submit claims for reimbursement for costs that exceed the amount normally allowed for the provision of special education and related services. There are three types of Pennsylvania Special Reimbursement Form: the Claim Form, the Expense Detail Form, and the Student Eligibility Form. The Claim Form is used to submit claims for reimbursement for costs that exceed the amount normally allowed for the provision of special education and related services. This form must include the total amount of the claim, the date of service, the student's name, and the services provided. The Expense Detail Form must be completed to provide additional information about the services provided and the costs associated with the service. This form must include the date of service, the type of service provided, the total cost of the service, and the amount of the reimbursement requested. The Student Eligibility Form must be completed to demonstrate that the student meets the criteria necessary to receive special education services. This form must include the student's name, date of birth, and disability.