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Non-Payroll Reimbursement Request Form - Vermont
11/20/2007 | Requests *Summary
This form was developed for the Flexible Choices program to request payments for services, goods and cash.
Author
Available Files
- Form PDF (12K, 1 page)
Keywords
Cash and Counseling; Fiscal Intermediary; Individualized Budget; Personal Assistant; Reimbursement Request Form
Topic
Consumer/Participant Direction, State/Agency Information
Type/Tool
Policy alerts, briefs, letters & papers, Template / Form
Source
Grantee produced, Vermont
State
Vermont, All States/Territories
Date Created
01/13/2010
Contact
Aris Solutions
PO Box 4409
White River Junction, VT. 05001
800-798-1658
PO Box 4409
White River Junction, VT. 05001
800-798-1658
Short URL
Permission to use any element of this document should be obtained by the above named contact person. Always name the originator as the source of this material.
* Reflects requests since January 1, 2007
Options
HCBS / Clearinghouse for the Community Living Exchange Collaborative / (http://www.hcbs.org)