"Reimbursement Request Checklist" - Arizona

Reimbursement Request Checklist is a legal document that was released by the Arizona Department of Homeland Security - a government authority operating within Arizona.

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Download "Reimbursement Request Checklist" - Arizona

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Arizona Department of Homeland Security
Reimbursement Request Checklist
(This checklist is not required to be submitted to AZDOHS)
REIMBURSEMENT REQUEST FORM (Form must not be altered, handwritten, or contain correction tape/white-out)
Reporting Period Dates:
Reporting Period From = Date cannot be prior to the beginning of the period of performance
Reporting Period to = Date cannot be after the end of the period of performance
Current Period - Enter amount you are seeking on this reimbursement
Year-to-Date - Enter total amount reimbursed to date (which includes any AZDOHS reductions to previous
reimbursements) PLUS the amount of this request
INVOICE COPY(IES) and/or SUPPORT DOCUMENTATION REQUIRED (Date of invoice must be within reporting period)
Training and
Operation
Planning/Personnel
Travel
Equipment
Final Reimbursement
Exercise
Stonegarden
• Time and Effort
• Daily Activity
• Invoices
• Attended: Agenda,
• Per diems, lodging,
• Must be submitted
Reports for all
Reports
only -
duration, location
or other travel related
within 45 calendar
projects that include
• Signed validation
Quotes not
• Sponsored:
exdpenditures must
days following the end
salary charges (not
Forms
acceptable
⁰Agenda, duration,
be in compliance with
of the Period of
including overtime
• Payroll Records for
location
Arizona General
Performance
and backfill)
personnel
⁰Number of
Accounting Office
• Copy(ies) of
• Payroll records for
expenditures
participants
Travel Policy rates
Purchase Order(s) and
personnel
(including backfill,
⁰Sign-in Roster
(https://gao.az.gov/tr
Packing/Receiving
expenditures
overtime and
⁰HSEEP Exercise
avel/welcome-gao-
Slip(s) may be
(including backfill,
Employee Related
Summary/After Action
travel)
requested after the
overtime and
Expenses)
Report
• Hotel receipt
period of performance
Employee Related
showing $0 balance
but within the
Expenses)
authorized 45 day
period
• All expenses must
be received and
invoiced prior to the
end of the Period of
Performance
PROOF OF PAYMENT - Acceptable Types (if invoice paid by credit card, proof of payment of credit card is
• Copy of Cancelled Check(s)
• Electronic Funds Transfer (EFT)
• Official Accounting
(Must include payee, date,
Transaction Detail
amount paid and warrant or EFT
number)
OTHER
• Quarterly Programmatic Reports must be current in order to be reimbursed
TWO SIGNATURES REQUIRED (Cannot be the same person)
• Preparer
• Authorized Agency Official
ANY QUESTIONS? Please call us at 602-542-7013
Arizona Department of Homeland Security
Reimbursement Request Checklist
(This checklist is not required to be submitted to AZDOHS)
REIMBURSEMENT REQUEST FORM (Form must not be altered, handwritten, or contain correction tape/white-out)
Reporting Period Dates:
Reporting Period From = Date cannot be prior to the beginning of the period of performance
Reporting Period to = Date cannot be after the end of the period of performance
Current Period - Enter amount you are seeking on this reimbursement
Year-to-Date - Enter total amount reimbursed to date (which includes any AZDOHS reductions to previous
reimbursements) PLUS the amount of this request
INVOICE COPY(IES) and/or SUPPORT DOCUMENTATION REQUIRED (Date of invoice must be within reporting period)
Training and
Operation
Planning/Personnel
Travel
Equipment
Final Reimbursement
Exercise
Stonegarden
• Time and Effort
• Daily Activity
• Invoices
• Attended: Agenda,
• Per diems, lodging,
• Must be submitted
Reports for all
Reports
only -
duration, location
or other travel related
within 45 calendar
projects that include
• Signed validation
Quotes not
• Sponsored:
exdpenditures must
days following the end
salary charges (not
Forms
acceptable
⁰Agenda, duration,
be in compliance with
of the Period of
including overtime
• Payroll Records for
location
Arizona General
Performance
and backfill)
personnel
⁰Number of
Accounting Office
• Copy(ies) of
• Payroll records for
expenditures
participants
Travel Policy rates
Purchase Order(s) and
personnel
(including backfill,
⁰Sign-in Roster
(https://gao.az.gov/tr
Packing/Receiving
expenditures
overtime and
⁰HSEEP Exercise
avel/welcome-gao-
Slip(s) may be
(including backfill,
Employee Related
Summary/After Action
travel)
requested after the
overtime and
Expenses)
Report
• Hotel receipt
period of performance
Employee Related
showing $0 balance
but within the
Expenses)
authorized 45 day
period
• All expenses must
be received and
invoiced prior to the
end of the Period of
Performance
PROOF OF PAYMENT - Acceptable Types (if invoice paid by credit card, proof of payment of credit card is
• Copy of Cancelled Check(s)
• Electronic Funds Transfer (EFT)
• Official Accounting
(Must include payee, date,
Transaction Detail
amount paid and warrant or EFT
number)
OTHER
• Quarterly Programmatic Reports must be current in order to be reimbursed
TWO SIGNATURES REQUIRED (Cannot be the same person)
• Preparer
• Authorized Agency Official
ANY QUESTIONS? Please call us at 602-542-7013