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)	Employee ID is a required field. Employee ID is a four digit number. If your Employee ID is less than four digits, add leading zeros to make four digits.
First Name	You may only enter letters, hyphens, apostrophes, periods, commas, and spaces for the First Name First Name is a required field.
Last Name	You may only enter letters, hyphens, apostrophes, periods, commas, and spaces for the Last Name Last Name is a required Field

Date Mileage Incurred	(format mm/dd/yy)Date is a required field. Date must be entered in the following formats: mm/dd/yy or mm-dd-yy
Purpose of Trip	(Choose One) Direct Support JTG Direct Service Mileage Medical Appointment Mental Health Therapy Parent Recruitment Supervised Visit Supervision Training Other You must make a selection.
Unit Charged	(Choose One) AA01 AA03 AA08 AA09 AA18 AP30 AP31 AP34 AP35 AP36 AP37 AP38 AR03 AS20 AS21 AS22 AS23 BA00 BR03 BY00 CM09 DP01 EC01 EC02 EC04 EC06 EC08 EC09 EC10 EC11 EC12 EC99 FC01 FC02 FD01 FV01 FV02 FV03 FV04 FV05 HS01 IN02 JT04 LP00 MD01 MP01 MV01 OP01 OP02 PA05 RC29 RR01 RS01 SH01 SH02 SK03 TL01 WM06 You must make a selection.
Approving Supervisor	--Select A Supervisor-- You must choose an approving Supervisor.
Miles Driven (Whole Miles)	Total Miles is a required field Total Miles must be a positive number. Total Miles can not be more than 999.
Starting Point	Starting Point is a required field. You can only enter letters, numbers, periods, commas, and dashes in the starting point field.
Midpoint (if any)	You can only enter letters, numbers, periods, commas, and dashes in the midpoint field.
Ending Point	Ending Point is a required field. You can only enter letters, numbers, periods, commas, and dashes in the ending point field.

  

---

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.