HomeMy WebLinkAboutrequestRequest for Reimbursement of South Florida HIDTA Overtime Expenses
4nstructions: This form must be signed by the HIDTA task force commander/manager certifying that the OT claimed is for HIDTA-related work and by the
agency representative certifying that the amounts claimed are correct and that reimbursement has not been or will not be provided by any other funding
source. One form for each agency within each initiative (Note: An investigator's cap consists of reimbursed OT from all HIDTA intiatives, HIDTA will track
cumulative OT reimbursement and inform task force commanders when an individual is approaching the cap). For reimbursement, agency must provide
backup documentation covering claim, consisting of. copies of investigator OT sheets, showing when he/she worked the HIDTA case; and copies of payroll
register, showing he/she was paid for that time, It is understood that the amount reflected in the payroll register may be more than the amount claimed, as
investigator may have been paid OT for non-H1OTA work as well.
Agency of investigators
below:
Address
Contact Person
Name of Investigator
TOTALS
A
Is this person assigned
FT to the above named
initiative? (Y or N)
B
OT hours claimed
from HIDTA this
period
Name of HIDTA
Initiative
Pay Period(s) of overtime Incurred this
claim
From:
To:
Telephone Number
c
Overtime Rate
OT reimbursement
Requested
(B x C)
Grant Number: (use
oldest grant first)
E
F
1 certify to the best of my knowledge that the above data are correct; that these are the correct overtime rates; that all outlays were made in accordance with
the grant or other agreement conditions; that they have not been and will not be reimbursed by any other entity; and that payment is due and has not been
previously requested.
Recipient Agency Representative:
Signature
Title Date
1 certify to the best of my knowledge that the above data are correct and that these individuals participated in the above -named HIDTA initiative during this
time period for the above -listed number of overtime hours.
HIDTA Task Force Commander:
Signature
Title Date
rev 4/13/05