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Community Care Mileage Reimbursement Form

  • Please be sure you complete the form accurately and review it carefully before submitting it. 

  • See Tips for Quick Use at the bottom of the page. 

  • Don't forget to click the button at the bottom or the data will not be captured.

  • Just want to view what you've already submitted for the current pay period or for previous pay periods?

***Mileage for pay periods needs to be entered in the mileage database by 11:59 pm Thursday following the close of the pay period and will be paid the following pay date (two weeks later). For example, mileage incurred 9/29/13 to 10/12/13 needs to be entered by Thursday, 10/17/13 by 11:59 pm and will be paid on pay date 11/1/13

Employee ID (also called ADP File Number or Badge Number)
First Name
Last Name  
Date Mileage Incurred (format mm/dd/yy)
Purpose of Trip
Unit Charged
Approving Supervisor
Miles Driven
(Whole Miles)
Starting Point
Midpoint (if any)
Ending Point


Tips for Quick Use

  • To fill out a second mileage form right after submitting one: Click the "New Record" button on the "Summary of Mileage Submitted" screen to go back to the entry screen with the information you just entered already filled in.
  • To speed data entry if the browser is closed between forms: Enter a field and type the first letter of the data to be entered (such as the first letter of your first name). If you've entered that data into the field below a drop-down box will appear with that choice. Select it using your mouse or down arrow.
  • To speed navigation between fields: Rather than using your mouse use the tab button on your keyboard.


Copyright © Community Care 2009. All rights reserved.Care 2009. All rights reserved.