Financial Management
The following forms can be completed online and then printed.
Application and Claim for Funds to Defray Burial Costs - Medicaid Aged, Blind and Disabled Recipients 35937/FM 0033
Completed by funeral homes to make an application to get burial costs reimbursed by the state for individuals on Medicaid due to age, being blind or disabled. Local DFR offices process these applications and claims are paid at Central Office, Financial Management.
Approval for Conference/Training/Travel 45116/FM 6005 (Microsoft Word version 6.0)
Authorization/Request for Paternity Blood Test 07859/FM 0435
Used by county prosecutor to authorize paternity testing (genetic testing) to establish paternity of a child for Title IV-D (Child Support).
Claim for Reimbursement - Expenditures - Approved District Plans - Title 45529/FM 0411
Profile Information - Hospital Care for the Indigent 42834/OFE 0133A
Report of Local Travel for Official Travel in Personal Car 23151/FM 1703
Report of Overtime 47506/PYL 2617 (in Excel)
Report of Repayment - Expenditures - Approved District Plans - Title 45531/FM 0413
These forms cannot be filled in online. They may be printed out and filled in by hand or typewriter.
Affidavit for Lost or Not Received Warrant 45735/FM 0007
Completed when a warrant is issued by the Auditor's office, but somehow does not reach the employee or the employee misplaces the warrant. This form is to be notarized and then sent to Travel Services and then on to the Auditor's office for re-issuance. These cannot be processed until 30 days after the warrant is issued.
Budget - Cooperative Agreement Appendix 1-a 41708/FM 0901
Claim for Support of Children in Custody of Institutions 28808/FM 0327
Equipment - Cooperative Agreement - Appendix I.C. 24223/FM 0902
Equipment Schedule 47391/FM 0910
Monthly Reimbursement Claim for Title IV-D Expenditures 24220/FM 0920
Personal Services Schedule - Cooperative Agreement Appendix 1-b 41707/FM 0900
Record of Monthly Time 45272/FM 0918
Report of Personal Services Expenditure 24221/FM 0919
