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SC Gas Mileage Reimbursement Trip Log 2011-2025 free printable template

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SOUTH CAROLINA GAS MILEAGE REIMBURSEMENT TRIP LOG Must be sent to DRIVER NAME DRIVER MAILING ADDRESS CITY/STATE/ZIP MEMBER NAME If different from Driver Trip Date Trip/Job LogistiCare Claims Department 503 Oak Place Suite 550 College Park GA 30349 RELATIONSHIP TO MEMBER DRIVER PHONE MEMBER ID Medical Provider Name Phone Physician/Clinician Signature Total Miles Name Phone Each date of service must have a physician or clinician signature in order for reimbursement to be approved. NOTE Each...
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How to fill out sc logisticare mileage reimbursement form

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How to fill out SC Gas Mileage Reimbursement Trip Log

01
Download or obtain the SC Gas Mileage Reimbursement Trip Log form.
02
Fill in your name and contact information at the top of the form.
03
Enter the date of each trip in the designated column.
04
Record the starting and ending locations for each trip.
05
Calculate the total miles driven for each trip and input that in the corresponding column.
06
Note the purpose of each trip in the provided section.
07
Add up the total miles for all trips and write it in the summary section.
08
Sign and date the form to certify the information is accurate.
09
Submit the completed form along with any required receipts or documentation.

Who needs SC Gas Mileage Reimbursement Trip Log?

01
Employees who use personal vehicles for work-related travel.
02
Contractors or consultants who are reimbursed for travel expenses.
03
Anyone eligible for mileage reimbursement according to company policy.
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People Also Ask about sc logisticare gas reimbursement

Reimbursed at a rate of $0.50 per traveled mile, personal satisfaction of helping others, FREE Emergency Kit, Modivcare driver training, etc. What are the requirements to be a Volunteer Driver? The requirements are: At least 18 years of age.
Modivcare is a healthcare services leader. Our company was created to address the social determinants of health (SDoH) by providing non-emergency medical transportation (NEMT), personal care, nutritious meals, and remote patient monitoring.
The rate is $0.54 per mile. The distance will be the number of miles from your home to your medical appointment. The miles will be given to you during your reservation phone call.
Effective January 1, 2022, the state mileage reimbursement rate increased to 58.5 cents per mile. Therefore, the mileage reimbursement rate for claimants is 58.5 cents per mile as of January 1, 2022.
Your health care provider must sign the form as proof that you were at your appointment. You will not receive payment for your trip unless your form is complete. The rate is $0.54 per mile.

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The SC Gas Mileage Reimbursement Trip Log is a document used to record mileage driven for work-related purposes to claim reimbursement for gas expenses incurred during business trips.
Employees who use their personal vehicles for business purposes and seek reimbursement for gas expenses are required to file the SC Gas Mileage Reimbursement Trip Log.
To fill out the SC Gas Mileage Reimbursement Trip Log, indicate the date of travel, starting and ending odometer readings, total miles driven, purpose of the trip, and any other required information as specified by the organization.
The purpose of the SC Gas Mileage Reimbursement Trip Log is to provide a detailed account of miles driven for business purposes, allowing employees to claim reimbursements accurately and efficiently.
The information that must be reported on the SC Gas Mileage Reimbursement Trip Log includes the date of the trip, starting and ending odometer readings, total mileage, purpose of travel, and any additional required details as per the reimbursement policy.
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