Form 10AD006E (ADM-6) "Travel Claim" - Oklahoma

What Is Form 10AD006E (ADM-6)?

This is a legal form that was released by the Oklahoma Department of Human Services - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2022;
  • The latest edition provided by the Oklahoma Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 10AD006E (ADM-6) by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Human Services.

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Download Form 10AD006E (ADM-6) "Travel Claim" - Oklahoma

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Travel Claim
Instructions
Purpose of form
Form 10AD006E, Travel
Claim, is used by non-employees who have incurred travel expenses while
providing an approved service for DHS or its clients. Claimants include foster parents, volunteers,
recently terminated DHS employees, and outside consultants.
Foster care and volunteer services include transporting foster children to medical appointments,
client meals, lodging, and other costs incurred during transport. Former DHS employees who can no
longer access the Speed-E-Travel reimbursement system use the form for reimbursement of
approved travel costs incurred when employed by DHS. Office of Management and Enterprise
Services (OMES) staff use the form for reimbursement of approved mileage incurred while providing
contracted information technology services for DHS.
Instructions
First-time claimants who have not already submitted a
Form 10CO135E, Vendor
Information, attach
a completed and signed Form 10CO0135E with a legible copy of the claimant's Social Security card.
A completed Form 10AD006E may not cover more than one fiscal year. Our state fiscal year begins
July 1 and ends June 30.
Claimant information. Select the appropriate claimant type and enter the claimant's name, phone
number with area code, home address, city, ZIP code + 4, Social Security number and vehicle tag.
The ZIP code + 4 is obtained at https://tools.usps.com.
For foster parent travel only. A case or referral number is entered when claim is the result of
transporting a client. Use a separate form for a different case number, the same trip may not be
claimed on two cases. Enter the caseworker's name and phone number with area code.
Travel information. Enter the following travel information:
Was travel out-of-state? Select yes or no. When yes and a state employee, a completed
Form
10AD002E,
Out-of-State Travel Authorization, signed by the DHS travel coordinator is required for
each out-of-state trip. Form 10AD002E is submitted to the DHS travel coordinator's office before
Financial Services processes and pays for out-of-state travel. State employees travelling overnight
must attach an agenda or itinerary when he or she attends a conference, meeting, or workshop. To
receive a per diem payment in lieu of meals and incidental costs for overnight travel, complete the
overnight travel table.
Overnight trip table. Claimants requesting reimbursement for overnight travel must complete the
table. Enter beginning and ending times and dates for overnight trips. Time specify a.m. or p.m.
Financial Services staff use this information to calculate the per diem reimbursement.
Trip information table. Enter requested information for each trip. Beginning and ending points of
travel must each include an address and city name. If travel began or ended at the home address in
"Claimant Information" section, "Home" may be entered instead of a full address. If the starting and
ending points are the same, it is not necessary to list them twice. In that case Round-trip must be set
to "Y". The purpose of the trip must be concise and clear. Case detail is used to support the business
purpose of the travel. Foster parents who transport a child enter the child's first name and last initial
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Travel Claim
Instructions
Purpose of form
Form 10AD006E, Travel
Claim, is used by non-employees who have incurred travel expenses while
providing an approved service for DHS or its clients. Claimants include foster parents, volunteers,
recently terminated DHS employees, and outside consultants.
Foster care and volunteer services include transporting foster children to medical appointments,
client meals, lodging, and other costs incurred during transport. Former DHS employees who can no
longer access the Speed-E-Travel reimbursement system use the form for reimbursement of
approved travel costs incurred when employed by DHS. Office of Management and Enterprise
Services (OMES) staff use the form for reimbursement of approved mileage incurred while providing
contracted information technology services for DHS.
Instructions
First-time claimants who have not already submitted a
Form 10CO135E, Vendor
Information, attach
a completed and signed Form 10CO0135E with a legible copy of the claimant's Social Security card.
A completed Form 10AD006E may not cover more than one fiscal year. Our state fiscal year begins
July 1 and ends June 30.
Claimant information. Select the appropriate claimant type and enter the claimant's name, phone
number with area code, home address, city, ZIP code + 4, Social Security number and vehicle tag.
The ZIP code + 4 is obtained at https://tools.usps.com.
For foster parent travel only. A case or referral number is entered when claim is the result of
transporting a client. Use a separate form for a different case number, the same trip may not be
claimed on two cases. Enter the caseworker's name and phone number with area code.
Travel information. Enter the following travel information:
Was travel out-of-state? Select yes or no. When yes and a state employee, a completed
Form
10AD002E,
Out-of-State Travel Authorization, signed by the DHS travel coordinator is required for
each out-of-state trip. Form 10AD002E is submitted to the DHS travel coordinator's office before
Financial Services processes and pays for out-of-state travel. State employees travelling overnight
must attach an agenda or itinerary when he or she attends a conference, meeting, or workshop. To
receive a per diem payment in lieu of meals and incidental costs for overnight travel, complete the
overnight travel table.
Overnight trip table. Claimants requesting reimbursement for overnight travel must complete the
table. Enter beginning and ending times and dates for overnight trips. Time specify a.m. or p.m.
Financial Services staff use this information to calculate the per diem reimbursement.
Trip information table. Enter requested information for each trip. Beginning and ending points of
travel must each include an address and city name. If travel began or ended at the home address in
"Claimant Information" section, "Home" may be entered instead of a full address. If the starting and
ending points are the same, it is not necessary to list them twice. In that case Round-trip must be set
to "Y". The purpose of the trip must be concise and clear. Case detail is used to support the business
purpose of the travel. Foster parents who transport a child enter the child's first name and last initial
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in this box. OMES and former employees enter case numbers, ticket numbers, or other trip-specific
information. Enter the miles for the trip in the Miles box. Miles for reimbursement are based on
mapping the travel between specific addresses in the beginning and ending points of travel box.
Claimants must use Google Maps to map the distance between addresses; claimants may use either
the fastest or shortest route. For a round-trip, claimants simply double the map miles. Miles are
rounded to the nearest whole mile, with .5 miles rounded up. Claimants do not need to submit maps
with claim. Mileage will be checked as needed and claims returned if Google Map miles do not match
the claimed miles, without adequate explanation.
Explain as necessary: Claimants may use this box to explain any trip in which the miles claimed
are not from Google Maps. This may occur when an address cannot be mapped or a significant
detour was necessary. In this case, provide the travel date and a full explanation of the difference,
including odometer readings.
Expenses claimed. Enter the following expense information:
Mileage reimbursement. When using the automated form, the Total Miles field is automatically
calculated from the miles on each trip and multiplied by the mileage rate to determine the mileage
reimbursement. When using the paper form, add together the miles from each trip and enter into the
Total Miles field. Multiple by the mileage rate on the form to determine mileage reimbursement.
Per diem. Financial Services staff calculate the per diem reimbursement in lieu of meals and
incidentals using the information from the overnight trip table and the current federal per diem rate for
the specified destination as published on the
GSA
website. The reimbursement is computed based
on the applicable rules for in-state and out-of-state per diem per Oklahoma Administrative Code
(OAC)
340:2-11-121. For state employees, an agenda or itinerary documenting the conference,
meeting, or other event requiring overnight travel is attached.
Lodging. The amount paid for the hotel. Attach original receipts showing the balance was paid in full.
Lodging rates, excluding taxes, does not exceed the daily rates for in-state and out-of-state lodging
as noted in
OAC
340:2-11-119.1. The rate caps are published on the
GSA
website.
Client meals. Enter the amount paid for the client's food only. Attach original receipts. When a
receipt includes food purchased for anyone other than the client, circle and label the food and
amounts for the client.
List other items. List other items such as tolls, local transportation, or miscellaneous expenses
incurred. Tolls and cab fare of less than $25 per expense event do not require a receipt. However,
receipts for items less than $25,when provided to the traveler, are submitted to better document the
claim. All other items require original receipts.
If more than one page is required for a single claim, sub-totals are labeled and noted for each
section. The total amount claimed is only shown on the final page and all pages are stapled together.
Coding. Enter the four digit finance account and the five digit finance location number to which this
expense will be charged.
Claimant signatures/claim approval. The claimant, the approving authority, and the State Office
approving authority sign and date Form 10AD006E. The division director sign and date claims over
90 days old. The 90 days start on the earliest travel day listed on Form 10AD006E.
Comments for DHS Financial Services and CWS administration only. This section is used only
by Financial Services and CWS administration, including the Foster Care and Adoption Support
Center staff to provide clarifying notes.
Routing
Routing of foster parent claims. Claims initiated by foster parents are routed to the approving
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authority. After approval, the claims are routed to the Foster Care and Adoption Support Center for
pre-audit. The Foster Care and Adoption Support Center routes the original to DHS Financial
Services. A copy is retained by the Foster Care and Adoption Support Center, and the claimant. After
Form 10AD006E and supporting documentation are audited and approved, DHS Financial Services
enters the approved amount and electronically transmits the claim to OMES. A warrant is generated
and sent to the claimant.
Routing of volunteer claims. All claims submitted by volunteers are routed to the DHS volunteer
coordinator for State office approval signature. A copy is retained by the volunteer coordinator and
the claimant. After approval, the volunteer coordinator routes the claim to DHS Financial Services.
After Form 10AD006E and supporting documentation are audited and approved, DHS Financial
Services enters the approved amount and electronically transmits the claim to OMES. A warrant is
generated and sent to the claimant.
Routing of all other travel claims. All other travel claims are submitted to the appropriate approving
authority for review. A copy is retained by the approving authority and the claimant. After review, the
approving authority sends the claim to DHS Financial Services. After Form 10AD006E and
supporting documentation are audited and approved, DHS Financial Services enters the approved
amount and electronically transmits the claim to OMES. A warrant is generated and sent to the
claimant.
Claimant Information
Foster Parent
Volunteer
Former Oklahoma Department of Human Services employee
Office of Management and Enterprise Services employee (OMES)
Other:
First name
M.I.
Last name
Phone number with area code
Home address
City
State
Zip code + 4
Social Security number
Vehicle tag number
For foster parent travel only:
KK number
Caseworker name
Phone number with area code
Travel Information
Was travel out-of-state?
Yes
No
When yes, state employees must complete and submit
Form 10AD002E, Out-of-State Travel
Authorization.
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Overnight trip table: When claiming per diem, provide the following information. State employees
must also attach an agenda when he or she attends a conference or training. Per diem, when
applicable, is calculated by DHS Financial Services.
Begin date
Begin time
End date
End time
mm/dd/yyyy
0:00 AM/PM
mm/dd/yyyy
0:00 AM/PM
Trip information table: Use Google Maps to find miles for each trip - it is not necessary to include
maps with your travel claim. When transporting child(ren), enter the first name and last initial in the
"case detail" column in the trip information table.
Beginning and ending
Round-
Case
Travel date
points of travel -
trip
Purpose of trip
Miles
detail
Use address and city name
Y/N
Explain as necessary (e.g. address could not be mapped; took a different route.)
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Expenses Claimed
x $0.58 =
Mileage reimbursement rounded to the nearest cent: Total Miles
5
Per diem (when applicable, Financial Services calculates):
Lodging (attach original receipts showing the balance paid in full):
Client meals (attach original receipts):
List other items:
Tolls
Local transport
(such as shuttle or taxi)
Miscellaneous
Grand Total
When claiming per diem, attach an agenda if you attended a conference or training.
Coding
Charge this claim to:
4 digit finance account
5 digit finance location
Claimant Signatures and Claim Approval
Submit
Claimant signature
Date
Authorized approval signature
Date
State office approval signature
U#
Date
Division director approval for claims over 90 days old
Date
Comments (Financial Services and CWS only):
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