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HAWAII FACILITY MILEAGE REIMBURSEMENT TRIP LOG Must be sent to: Medicare Claims Department 2552 West Erie Drive, Suite 101 Tempe, AZ 85282FACILITY NAME: ___ DRIVER NAME :___ FACILITY MAILING ADDRESS:___

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How to fill out mileage reimbursement form

01

Obtain a blank mileage reimbursement form from your employer or HR department.

02

Fill out your name, employee ID, department, and contact information at the top of the form.

03

Record the date of travel, starting location, destination, and purpose of the trip for each trip you are seeking reimbursement for.

04

Log the starting and ending mileage for each trip, along with the total miles traveled.

05

Calculate the total amount of reimbursement due based on the mileage rate provided by your employer.

06

Submit the completed form, along with any required documentation (such as receipts or approval signatures), to the designated person or department for review and processing.

Who needs mileage reimbursement form?

01

Employees who use their personal vehicles for work-related travel

02

Contractors or freelancers who need to be reimbursed for travel expenses

03

Sales representatives or professionals who regularly visit clients or attend meetings off-site

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What is mileage reimbursement form?

A mileage reimbursement form is a document used by employees to report the number of miles driven for business purposes in order to be reimbursed for their travel expenses.

Who is required to file mileage reimbursement form?

Employees who use their personal vehicles for business purposes and are eligible for mileage reimbursement are required to file a mileage reimbursement form.

How to fill out mileage reimbursement form?

To fill out a mileage reimbursement form, employees need to accurately record the date, starting location, destination, purpose of the trip, and number of miles driven for each business-related journey.

What is the purpose of mileage reimbursement form?

The purpose of a mileage reimbursement form is to ensure employees are fairly compensated for the use of their personal vehicles for work-related travel.

What information must be reported on mileage reimbursement form?

The information reported on a mileage reimbursement form typically includes the date of travel, starting and ending locations, purpose of the trip, and total number of miles driven.

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