Presented by Victoria Solis California Emergency Communications Branch (CA Branch)

Transcription

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2 REIMBURSEMENTS Presented by Victoria Solis California Emergency Communications Branch (CA Branch)

3 Reimbursement Topics Recent Changes Annual Training Allotment Claims County Coordinator Expense Claims Streamlining Reimbursement Claims Questions

4 Recent Changes Reimbursement Coordinator Centralized CA Operations Manual Chapter III-Funding (June 2014) Reimbursement Claim Forms Revised June 2014 (TDe-290 & TDe-290A) Detailed Documentation Required on Claims

5 Annual Training Allotment Claims Submit Claim(s) within 60 days of Training Submit Separate from County Coordinator (CC) Expense Claims Use State Travel Reimbursement Rates (Handout) ATA for CC & PSAP is $3000 per fiscal year (July 1 through June 30)

6 9-1-1 County Coordinator Expense Claims Submit Claim(s) Quarterly Complete Reimbursement Claim Support Documents (TDe-290A) Front & Back Original Signature on Reimbursement Claim Forms (TDe-290 & TDe-290A)

7 COMPLETING REIMBURSEMENT CLAIMS

8 Reimbursement Claim Forms Please use the most current revision 6/2014 of the Reimbursement Claim Forms TDe-290 and TDe-290A. This will help expedite reimbursement processing. Complete this form electronically.

9 Mail Reimbursement Claims Original form must be mailed to our office via U.S. Mail as noted in the upper right hand corner of the form.

10 Agency Information Complete your agency information on the left side along with the PSAP manager name, , phone and fax numbers. If we need to ask a question about the claim, this would be the person to contact.

11 Reimbursement Claim Types The form is designed to be completed on the computer. Check the appropriate box for the type of claim you are submitting. Other allows room for typing in the box just below the checkbox.

12 Reimbursement Claim Types Continued All reimbursement claims must be submitted no later than ninety (90) calendar days after the close of the fiscal year in which the funds have been expended. Claims should be filed separately:

13 Reimbursement Description Please type a basic description of the equipment, service or activity in this section (if applicable). CPE Maintenance or CPE Equipment description should be entered in this area.

14 Reimbursement for ATA List items to be reimbursed in the Description column: Registration Hotel Airfare Itemized receipts are required as supporting documents. Copies of account ledgers are not permitted as supporting documents. 3 rd Party booking company receipts are not acceptable they do not provide itemized receipts.

15 Reimbursement for ATA Continued Tracking # is issued by the CA Branch. Time Period of Claims are the date(s) or date range(s). Enter each item cost to be reimbursed. The total of each item cost will be automatically added in the Reimbursement Claim Total.

16 Reimbursement for ATA Continued Multiple attendees, with their own expenses to be reimbursed, should be listed individually in the description area. Reimbursement rates are based upon CalHR rates of reimbursement.

17 Reimbursement for All Claims Be sure the Financial Official Authorized To Sign For Public Agency signature is not the same as the claimant. Please be sure to sign and date the form. Mail completed claim via U.S. Mail to our office: Public Safety Communications 601 Sequoia Pacific Blvd, Mail Station 911 Sacramento, CA

18 Reimbursement Claim Support Document (TDe-290A) This is a supporting document to be submitted with the Reimbursement Claim (TDe-290) Form. TDe-290A (Rev. 6/2014) is designed to be completed on a computer. Enter the name of your agency. Enter the claimants name. Enter the month/year. U.S. Mail the completed form to: Public Safety Communications 601 Sequoia Pacific Blvd., MS-911 Sacramento, CA

19 TDe-290A Instructions Continued Enter the number of hours per categories A-G performed on the specific date of the month. The Total column highlighted in yellow automatically adds the number of hours entered throughout the month.

20 TDe-290A Instructions Continued Enter the Total Hours in the formula bar below. Enter the hourly rate of the claimant.

21 TDe-290A Instructions Continued The yellow box at the end of the row automatically calculates the Total Hours times the Hourly Rate. This is the amount to be entered on the Reimbursement Claim (TDe-290) Form.

22 TDe-290A Instructions Continued Enter the number of miles travelled on the date(s) of the month. The total number of miles are added automatically in the yellow Total box at the end of the row. Enter the Total Miles in the first yellow box on the bar below. Enter the current mileage rate (per mile) in the second box. Current rate available on the CalHR website:

23 TDe-290A Instructions Continued When claiming mileage, please attach a mapping document to support the mileage (i.e. MapQuest, Google Maps, etc.)

24 TDe-290A Instructions Continued The Responsible Official Authorized To Sign for Public Agency Signature field must be signed. Supporting documents to the Reimbursement Claim (TDe-290) Form must be sent via U.S. Mail to our office: Public Safety Communications, 601 Sequoia Pacific Blvd., MS-911 Sacramento, CA

25 TDe-290A Instructions Continued Enter the description (in date order) of the activity performed on the date(s) specified on the front side of this form.

26 REIMBURSEMENT COORDINATOR Victoria Solis (916)

27 QUESTIONS

28 State of California, California Emergency Communications Branch (CA Branch) REIMBURSEMENT CLAIM U.S. Mail form to: Public Safety Communications, CA Branch TDe-290 (Rev. 6/2014) Complete form electronically Public Agency: Address: City, State, Zip: PSAP Manager: Address: Phone Number: Fax Number: Always Ready PSAP Main Street Hometown, CA Lt. John Doe (XXX) xxx-xxxx (XXX) xxx-xxxx Annual Training Alotment - County Coordinator Bob Smith - CALNENA San Diego 601 Sequoia Pacific Blvd., MS-911 Sacramento, CA (916) Accounts Payable Name and Address Enter Accounts Payable Name and address if different from the Public Agency Type of Reimbursement Claim: All reimbursement claims must be submitted no later than ninety (90) calendar days after the close of the fiscal year in which funds have been expended. Annual Training Allotment - CC Annual Training Allotment - PSAP County Coordinator Expenses County Coordinator Task Force CPE Equipment CPE Maintenance Education Materials Description of equipment and services being submitted for reimbursement in accordance with CA Branch Operations Manual, Chapter III (Rev. 2014): Other: Please provide itemized, detailed receipt copies for each person named as a claimant and item claimed Description Issued by the CA Branch Tracking# Please provide date range(s) Time Period of Claim Registration Jan 27-29, 2014 Lodging Jan 27-29, 2014 Airfare Jan 27-29, 2014 Car Rental Parking Wages - TDe-290A attached (24 hours) Jan 27-29, 2014 Jan 27-29, 2014 Jan 27-29, 2014 Mileage - MapQuest attached Jan 27-29, 2014 Amount claimed per item description Total Cost Per Item , CA Branch Use Only Amount Approved REIMBURSEMENT CLAIM TOTAL 2, I declare under penalty of perjury that the amount requested for each reimbursement is correct and is a legitimate claim for reimbursement from the CA Branch, State Emergency Telephone Number Account. FINANCIAL OFFICIAL AUTHORIZED TO SIGN FOR PUBLIC AGENCY (other than claimant named for reimbursement) Name: Title: King of the Money Signature: Date: 6/25/2014 Address: Mr. Money Baggs Dollar Drive, Hometown, CA mbaggs@alwaysreadypsap.ca.gov Phone: (XXX) xxx-xxxx RECOMMENDED APPROVAL PSAP Code CA Branch Use Only Date APPROVED BY Date PCA: Index: 7350 Fiscal Year: Object Code: 702. Approved Amount: Approved By:

29 u Vendor Number: Date: TDe-290 Instructions v Enter the name of your Agency, address, PSAP manager s name, , phone, and fax number in this section. w Enter the name of your Accounts Payable information in this section if different from Public Agency. Specify claim type by clicking on the appropriate box. County Coordinator (CC) Expense claims are separate from Annual Training Allotment County Coordinator (ATA-CC) claims and should be filed separately from each other. Check only one box. Attach supporting documents that support only that claim. If your claim does not have a box to check, then check Other: Just below the box is space for you to type in exactly what type of claim it is. Describe the equipment and or service to be reimbursed in compliance with the CA Branch Operations Manual, Chapter III in this section. Enter a description of the item to be reimbursed. Such as: Name of claimant- CALNENA Registration. Claimant Lodging Claimant Airfare Claimant Parking, Taxi, Toll fees, etc. When claiming Wages while attending a training event a TDe-290A form must also be attached with this TDe-290. When claiming mileage on form TDe-290A a MapQuest or other 3 rd party mapping document must also be attached with this TDe-290. x If CA Branch has issued a TD-288 form enter the number in this section. Otherwise leave this blank Enter the date range(s) of this claim here. Enter the amount paid per item to be reimbursed. The total dollar amount will automatically add totals at the bottom of the column. The grey shaded area is for the CA Branch use only. Please do not enter anything in this area. y The financial official for your agency should be entered here with a hard signature on the original form. This cannot be a person named as a claimant in the claim. Signature is required for claim consideration. The completed form must be U.S. Mailed to: Public Safety Communications CA Branch 601 Sequoia Pacific Blvd, MS-911 Sacramento, CA If you have any questions at all about how to complete this form please contact the Reimbursement Claim Coordinator at the CA Branch. (916) M-F, 8am-5pm

30 TDe-290 Instructions (Rev. 6/2014)

31 State of California, California Emergency Communications Branch (CA Branch) REIMBURSEMENT CLAIM U.S. Mail form to: Public Safety Communications, CA Branch TDe-290 (Rev. 6/2014) Complete form electronically Public Agency: Address: City, State, Zip: PSAP Manager: Address: Phone Number: Fax Number: Always Ready PSAP Main Street Hometown, CA Lt. John Doe (XXX) xxx-xxxx (XXX) xxx-xxxx Type of Reimbursement Claim: All reimbursement claims must be submitted no later than ninety (90) calendar days after the close of the fiscal year in which funds have been expended. Annual Training Allotment - CC Annual Training Allotment - PSAP County Coordinator Expenses County Coordinator Task Force CPE Equipment CPE Maintenance Annual Training Alotment - County Coordinator Bob Smith - CALNENA San Diego 601 Sequoia Pacific Blvd., MS-911 Sacramento, CA (916) Accounts Payable Name and Address Enter Accounts Payable Name and address if different from the Public Agency Education Materials Description of equipment and services being submitted for reimbursement in accordance with CA Branch Operations Manual, Chapter III (Rev. 2014): Other: Please provide itemized, detailed receipt copies for each person named as a claimant and item claimed Description Issued by the CA Branch Tracking# Please provide date range(s) Time Period of Claim Bob Smith: Registration Jan 27-29, 2014 Bob Smith: Lodging Jan 27-29, 2014 Bob Smith: Airfare Jan 27-29, 2014 Jane Doh: Registration Jan 27-29, 2014 Jane Doh: Lodging Jan 27-29, 2014 Jane Doh: Airfare Jan 27-29, 2014 Amount claimed per item description Total Cost Per Item CA Branch Use Only Amount Approved REIMBURSEMENT CLAIM TOTAL 1, I declare under penalty of perjury that the amount requested for each reimbursement is correct and is a legitimate claim for reimbursement from the CA Branch, State Emergency Telephone Number Account. FINANCIAL OFFICIAL AUTHORIZED TO SIGN FOR PUBLIC AGENCY (other than claimant named for reimbursement) Name: Title: King of the Money Signature: Date: 6/25/2014 Address: Mr. Money Baggs Dollar Drive, Hometown, CA mbaggs@alwaysreadypsap.ca.gov Phone: (XXX) xxx-xxxx RECOMMENDED APPROVAL PSAP Code CA Branch Use Only Date APPROVED BY Date PCA: Index: 7350 Fiscal Year: Object Code: 702. Approved Amount: Approved By:

32 u Vendor Number: Date: TDe-290 Instructions v Enter the name of your Agency, address, PSAP manager s name, , phone, and fax number in this section. w Enter the name of your Accounts Payable information in this section if different from Public Agency. Specify claim type by clicking on the appropriate box. County Coordinator (CC) Expense claims are separate from Annual Training Allotment County Coordinator (ATA-CC) claims and should be filed separately from each other. Check only one box. Attach supporting documents that support only that claim. If your claim does not have a box to check, then check Other: Just below the box is space for you to type in exactly what type of claim it is. Describe the equipment and or service to be reimbursed in compliance with the CA Branch Operations Manual, Chapter III in this section. Enter a description of the item to be reimbursed. Such as: Name of claimant- CALNENA Registration. Claimant Lodging Claimant Airfare Claimant Parking, Taxi, Toll fees, etc. When claiming Wages while attending a training event a TDe-290A form must also be attached with this TDe-290. When claiming mileage on form TDe-290A a MapQuest or other 3 rd party mapping document must also be attached with this TDe-290. x If CA Branch has issued a TD-288 form enter the number in this section. Otherwise leave this blank Enter the date range(s) of this claim here. Enter the amount paid per item to be reimbursed. The total dollar amount will automatically add totals at the bottom of the column. The grey shaded area is for the CA Branch use only. Please do not enter anything in this area. y The financial official for your agency should be entered here with a hard signature on the original form. This cannot be a person named as a claimant in the claim. Signature is required for claim consideration. The completed form must be U.S. Mailed to: Public Safety Communications CA Branch 601 Sequoia Pacific Blvd, MS-911 Sacramento, CA If you have any questions at all about how to complete this form please contact the Reimbursement Claim Coordinator at the CA Branch. (916) M-F, 8am-5pm

33 TDe-290 Instructions (Rev. 6/2014)

34 State of California REIMBURSEMENT CLAIM SUPPORT DOCUMENT TDe-290A (REV 06/2014) California Emergency Communications Branch U.S. Mail form to: Public Agency: Always Ready PSAP Claimant Name: Bob Smith Claim Month/Year: I. - Duties Performed (Please specify hours spent by this individual performing activities within an authorized task category per day) Public Safety Communications 601 Sequoia Pacific Blvd. MS-911 Sacramento, CA (916) Total A 0 B 0 C 0 D 0 E 0 F 0 G TASK ACTIVITY CATEGORIES (as defined in the Operations Manual, Chapter III, revised 2014) Total Hours 24 A County Coordinator - Coordination of ESN assignments for call delivery - Please list detail of activities by date on reverse side of this form. B County Coordinator - Coordination of related activities to PSAPs - Please list detail of activities by date on reverse side of this form. C County Coordinator - Coordination of wireless related activities - Please list detail of activities by date on reverse side of this form. D County Coordinator - County Coordinator Task Force (CCTF) related activities - (pre-approval required) - Please list detail of activities by date on reverse side of this form. E - Special meeting / projects / training - (pre-approval required) F - Countywide PSAP Manager's meeting - (pre-approval required) G - Annual Training Allotment (ATA) - (pre-approval required) Jan-14 Total Hours: 24 x Hourly Rate: $48.75 = $1, II. Mileage (Please identify total miles for day corresponding with above task activity category) Attach a mapping document to support mileage Total #### #### Total Miles: X Mileage Rate: = $11.74 I declare under penalty of perjury that the time and mileage identified in the task activity categories noted above were performed as defined in the Operations Manual, Chapter III, revision RESPONSIBLE OFFICIAL AUTHORIZED TO SIGN FOR PUBLIC AGENCY Name: Signature: Title: Date: Phone:

35 Page 1 of 2 TASK ACTIVITY DETAIL Please list the date, the number of hours, and a description of the tasks performed as listed on the front side of this form. DATE # HOURS ACTIVITY DESCRIPTION DATE # HOURS ACTIVITY DESCRIPTION 27-Jan 8 Active Shooter Pre Event Class 28-Jan 8 CALNENA Main Event 29-Jan 8 CALNENA Main Event

36 TDe-290A Rev. 6/2014 Page 2 of 2

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39 STATE OF CALIFORNIA T R A V E L R E I M B U R S E M E N T R A T E S P r e p a r e d f o r P S A P s a n d C o u n t y C o o r d i n a t o r s Fiscal Year (July 1, 2014 June 30, 2015) MEALS & INCIDENTALS ~ MILEAGE ~ TRANSPORTATION ~ LODGING MEALS & INCIDENTALS MILEAGE TRANSPORTATION Per Diem RATE Per Mile RATE RATE Breakfast $ 7 1/1/ Cents Air Actual Expense Bus Actual Expense Lunch $ 11 Parking Actual Expense Railway Actual Expense Dinner $ 23 Rental Car Actual Expense Taxi Actual Expense Incidentals $ 5 Tolls Actual Expense PER NIGHT LODGING RATES The State will reimburse actual lodging expenses for all Counties/Cities located in California up to the State rate of $90 (plus tax and fees ) with the exception of the COUNTY following Counties/Cities listed below. Receipts Required Up to: STATE RATE COUNTY Up to: STATE RATE Alameda $ 125 Sacramento $ 95 Los Angeles - Excluding Santa Monica $ 120 San Diego $ 125 Los Angeles - Santa Monica $ 150 San Francisco $ 150 Monterey $ 125 San Mateo $ 125 Napa $ 95 Santa Clara $ 125 Orange $ 120 Ventura $ 120 Riverside $ 95 Lodging for pre-approved non-state sponsored conferences: The State will reimburse receipted lodging in excess of the State rate when the lodging rate is contracted by the sponsor for the event. 1 of 1 6/25/2014

40 State of California REIMBURSEMENT CLAIM SUPPORT DOCUMENT TDe-290A (REV 06/2014) California Emergency Communications Branch U.S. Mail form to: Public Agency: Always Ready PSAP Claimant Name: Bob Smith Claim Month/Year: I. - Duties Performed (Please specify hours spent by this individual performing activities within an authorized task category per day) Public Safety Communications 601 Sequoia Pacific Blvd. MS-911 Sacramento, CA (916) Total A B C D E 0 F 0 G 0 TASK ACTIVITY CATEGORIES (as defined in the Operations Manual, Chapter III, revised 2014) Total Hours 19.5 A County Coordinator - Coordination of ESN assignments for call delivery - Please list detail of activities by date on reverse side of this form. B County Coordinator - Coordination of related activities to PSAPs - Please list detail of activities by date on reverse side of this form. C County Coordinator - Coordination of wireless related activities - Please list detail of activities by date on reverse side of this form. D County Coordinator - County Coordinator Task Force (CCTF) related activities - (pre-approval required) - Please list detail of activities by date on reverse side of this form. E - Special meeting / projects / training - (pre-approval required) F - Countywide PSAP Manager's meeting - (pre-approval required) G - Annual Training Allotment (ATA) - (pre-approval required) Jan-14 Total Hours: 19.5 x Hourly Rate: $43.75 = $ II. Mileage (Please identify total miles for day corresponding with above task activity category) Attach a mapping document to support mileage Total 0.00 Total Miles: X Mileage Rate: = $0.00 I declare under penalty of perjury that the time and mileage identified in the task activity categories noted above were performed as defined in the Operations Manual, Chapter III, revision RESPONSIBLE OFFICIAL AUTHORIZED TO SIGN FOR PUBLIC AGENCY Name: Cpt. Bob Smith Signature: Title: Date: County Coordinator 6/25/ bsmith@alwaysreadypsap.ca.gov Phone: (XXX) xxx-xxxx

41 Page 1 of 2 TASK ACTIVITY DETAIL Please list the date, the number of hours, and a description of the tasks performed as listed on the front side of this form. DATE # HOURS ACTIVITY DESCRIPTION DATE # HOURS Jan TVW ESN assignment w/att Jan Telephone conference w/chp Jan Mapping Coordination w/chp Jan 9 1 Telephone conference w/ca Branch Jan Cell Tower Assignments - TVW w/att Jan TVW ESN assignment w/att Jan TD-280 for CLEC - VoIP Jan Cell Tower Assignment - TVW w/att Jan Telephone conference w/ca Branch Jan 24 3 Mapping Coordination w/chp Jan TVW ESN assignment w/att Jan Telephone conference w/chp Jan TVW ESN assignment w/att ACTIVITY DESCRIPTION TDe-290A Rev. 6/2014 Page 2 of 2

42 State of California REIMBURSEMENT CLAIM SUPPORT DOCUMENT TDe-290A (REV 06/2014) California Emergency Communications Branch Public Agency: Always Ready PSAP Claimant Name: Bob Smith Claim Month/Year: Feb Total A B C D E 0 F 0 G 0 TASK ACTIVITY CATEGORIES (as defined in the Operations Manual, Chapter III, revised 2014) Total Hours 19.5 A County Coordinator - Coordination of ESN assignments for call delivery - Please list detail of activities by date on reverse side of this form. B County Coordinator - Coordination of related activities to PSAPs - Please list detail of activities by date on reverse side of this form. C County Coordinator - Coordination of wireless related activities - Please list detail of activities by date on reverse side of this form. D County Coordinator - County Coordinator Task Force (CCTF) related activities - (pre-approval required) - Please list detail of activities by date on reverse side of this form. E - Special meeting / projects / training - (pre-approval required) F - Countywide PSAP Manager's meeting - (pre-approval required) G - Annual Training Allotment (ATA) - (pre-approval required) Total Hours: 19.5 x Hourly Rate: $43.75 = $ U.S. Mail form to: I. - Duties Performed (Please specify hours spent by this individual performing activities within an authorized task category per day) Public Safety Communications 601 Sequoia Pacific Blvd. MS-911 Sacramento, CA (916) II. Mileage (Please identify total miles for day corresponding with above task activity category) Attach a mapping document to support mileage Total 0.00 Total Miles: X Mileage Rate: = $0.00 I declare under penalty of perjury that the time and mileage identified in the task activity categories noted above were performed as defined in the Operations Manual, Chapter III, revision RESPONSIBLE OFFICIAL AUTHORIZED TO SIGN FOR PUBLIC AGENCY Name: Cpt. Bob Smith Title: County Coordinator Signature: Date: 6/25/ bsmith@alwaysreadypsap.ca.gov Phone: (XXX) xxx-xxxx

43 Page 1 of 2 TASK ACTIVITY DETAIL Please list the date, the number of hours, and a description of the tasks performed as listed on the front side of this form. DATE # HOURS ACTIVITY DESCRIPTION DATE # HOURS ACTIVITY DESCRIPTION Jan TVW ESN assignment w/att Jan Telephone conference w/chp Jan Mapping Coordination w/chp Jan 9 1 Telephone conference w/ca Branch Jan Cell Tower Assignments - TVW w/att Jan TVW ESN assignment w/att Jan TD-280 for CLEC - VoIP Jan Cell Tower Assignment - TVW w/att Jan Telephone conference w/ca Branch Jan 24 3 Mapping Coordination w/chp Jan TVW ESN assignment w/att Jan Telephone conference w/chp Jan TVW ESN assignment w/att TDe-290A Rev. 6/2014 Page 2 of 2

44 State of California, California Emergency Communications Branch (CA Branch) REIMBURSEMENT CLAIM U.S. Mail form to: Public Safety Communications, CA Branch TDe-290 (Rev. 6/2014) Complete form electronically Public Agency: Address: City, State, Zip: PSAP Manager: Address: Phone Number: Fax Number: Always Ready PSAP Main Street Hometown, CA Lt. John Doe (XXX) xxx-xxxx (XXX) xxx-xxxx County Coordinator Expenses - Bob Smith - 1st Quarter Sequoia Pacific Blvd., MS-911 Sacramento, CA (916) Accounts Payable Name and Address Enter Accounts Payable Name and address if different from the Public Agency Type of Reimbursement Claim: All reimbursement claims must be submitted no later than ninety (90) calendar days after the close of the fiscal year in which funds have been expended. Annual Training Allotment - CC Annual Training Allotment - PSAP County Coordinator Expenses County Coordinator Task Force CPE Equipment CPE Maintenance Education Materials Description of equipment and services being submitted for reimbursement in accordance with CA Branch Operations Manual, Chapter III (Rev. 2014): Other: Please provide itemized, detailed receipt copies for each person named as a claimant and item claimed Issued by the CA Branch Please provide date range(s) Amount claimed per item description CA Branch Use Only Description 1st Quarter Bob Smith Tracking# Time Period of Claim Jan-14 Feb-14 Mar-14 Total Cost Per Item Amount Approved REIMBURSEMENT CLAIM TOTAL 2, I declare under penalty of perjury that the amount requested for each reimbursement is correct and is a legitimate claim for reimbursement from the CA Branch, State Emergency Telephone Number Account. FINANCIAL OFFICIAL AUTHORIZED TO SIGN FOR PUBLIC AGENCY (other than claimant named for reimbursement) Name: Title: King of the Money Signature: Date: 6/25/2014 Address: Mr. Money Baggs Dollar Drive, Hometown, CA mbaggs@alwaysreadypsap.ca.gov Phone: (XXX) xxx-xxxx RECOMMENDED APPROVAL PSAP Code CA Branch Use Only Date APPROVED BY Date PCA: Index: 7350 Fiscal Year: Object Code: 702. Approved Amount: Approved By:

45 u Vendor Number: Date: TDe-290 Instructions v Enter the name of your Agency, address, PSAP manager s name, , phone, and fax number in this section. w Enter the name of your Accounts Payable information in this section if different from Public Agency. Specify claim type by clicking on the appropriate box. County Coordinator (CC) Expense claims are separate from Annual Training Allotment County Coordinator (ATA-CC) claims and should be filed separately from each other. Check only one box. Attach supporting documents that support only that claim. If your claim does not have a box to check, then check Other: Just below the box is space for you to type in exactly what type of claim it is. Describe the equipment and or service to be reimbursed in compliance with the CA Branch Operations Manual, Chapter III in this section. Enter a description of the item to be reimbursed. Such as: Name of claimant- CALNENA Registration. Claimant Lodging Claimant Airfare Claimant Parking, Taxi, Toll fees, etc. When claiming Wages while attending a training event a TDe-290A form must also be attached with this TDe-290. When claiming mileage on form TDe-290A a MapQuest or other 3 rd party mapping document must also be attached with this TDe-290. x If CA Branch has issued a TD-288 form enter the number in this section. Otherwise leave this blank Enter the date range(s) of this claim here. Enter the amount paid per item to be reimbursed. The total dollar amount will automatically add totals at the bottom of the column. The grey shaded area is for the CA Branch use only. Please do not enter anything in this area. y The financial official for your agency should be entered here with a hard signature on the original form. This cannot be a person named as a claimant in the claim. Signature is required for claim consideration. The completed form must be U.S. Mailed to: Public Safety Communications CA Branch 601 Sequoia Pacific Blvd, MS-911 Sacramento, CA If you have any questions at all about how to complete this form please contact the Reimbursement Claim Coordinator at the CA Branch. (916) M-F, 8am-5pm

46 TDe-290 Instructions (Rev. 6/2014)