Directions on Completing the Mileage Chart
The mileage claim form is a State Board of Accounts approved form and they require that the original be submitted for payment; therefore copies or faxes will be returned to you in exchange for the original document. State Board of Accounts requires odometer readings between buildings, unless we have a Fixed Distance Mileage Chart. We publish a updated Mileage Chart periodically, upon completion of processing the claims submitted that month.
- Enter your name in top right comer
- Enter the Year and specific Date of Travel
- Enter Building you are traveling from in Column 2 and Building you are traveling to in Column 3.
- Multiple destinations are not allowed in the TO column unless you are returning to your starting point.
- Enter odometer readings in Column 4 titled "Odometer Reading"; if there is no distance identified on the Mileage Chart.
- Enter Nature of Business in Column 5. (Examples: Therapy, Meeting, Testing, Case Conference, Workshop, etc.) This cannot be left blank.
- Enter the miles you traveled in Column 6 titled (Auto Miles Traveled) (either from the mileage chart or from your odometer readings).
- Date and Sign the form at the bottom. Without your signature we can not pay your claim.