PFS LE Request for Reimbursement Form

PFS LE Request for Reimbursement Form

All funds requested MUST be presented on this form. All forms MUST be submitted electronically; no hand writing will be accepted.
Date

MonthDayYear
Department*
Agency Federal ID # *
This can also been know as the vendor number.
Name*

First NameLast Name
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reporting period for date of service:
From*

MonthDayYear
Date
To*

MonthDayYear
Date

Expense #1

You must enter each expense individually. To add additional expenses, select "yes" when asked if you have another expense to request for reimbursement below. All expenses should mirror the contents of your submitted budget. At the end, you will need to upload all receipts or proof of purchases.
Expense Category *
Strategy*

Compliance checksShoulder tap operationsParty patrolsUnderage drinking presentationsInterdiction activitiesMarijuana-related presentationsMethamphetamine-related presentationsProfessional Development - Pre-approvedOther
Requested Amount*
Please enter the requested amount for this particular expense.
Description*
For personnel and miles please complete the Law Enforcement Reimbursement Calculation Form to match this reimbursement amount. For supplies, please provide the type and number of supplies purchased. For contractual, please provide the contractor/consultant name and their service. For training, please provide the individuals who attended.
Do you have another expense to request for reimbursement?*

Expense #2

You must enter each expense individually. To add additional expenses, select "yes" when asked if you have another expense to request for reimbursement below. All expenses should mirror the contents of your submitted budget. At the end, you will need to upload all receipts or proof of purchases.
Expense Category*
Strategy*

Compliance checksShoulder tap operationsParty patrolsUnderage drinking presentationsInterdiction activitiesMarijuana-related presentationsMethamphetamine-related presentationsProfessional Development - Pre-approvedOther
Requested Amount*
Please enter the requested amount for this particular expense.
Description*
For personnel and miles please complete the Law Enforcement Reimbursement Calculation Form to match this reimbursement amount. For supplies, please provide the type and number of supplies purchased. For contractual, please provide the contractor/consultant name and their service. For training, please provide the individuals who attended.
Do you have another expense to request for reimbursement?*

Expense #3

You must enter each expense individually. To add additional expenses, select "yes" when asked if you have another expense to request for reimbursement below. All expenses should mirror the contents of your submitted budget. At the end, you will need to upload all receipts or proof of purchases.
Expense Category*
Strategy*

Compliance checksShoulder tap operationsParty patrolsUnderage drinking presentationsInterdiction activitiesMarijuana-related presentationsMethamphetamine-related presentationsProfessional Development - Pre-approvedOther
Requested Amount*
Please enter the requested amount for this particular expense.
Description*
For personnel and miles please complete the Law Enforcement Reimbursement Calculation Form to match this reimbursement amount. For supplies, please provide the type and number of supplies purchased. For contractual, please provide the contractor/consultant name and their service. For training, please provide the individuals who attended.
Do you have another expense to request for reimbursement?*

Expense #4

You must enter each expense individually. To add additional expenses, select "yes" when asked if you have another expense to request for reimbursement below. All expenses should mirror the contents of your submitted budget. At the end, you will need to upload all receipts or proof of purchases.
Expense Category*
Strategy*

Compliance checksShoulder tap operationsParty patrolsUnderage drinking presentationsInterdiction activitiesMarijuana-related presentationsMethamphetamine-related presentationsProfessional Development - Pre-approvedOther
Requested Amount*
Please enter the requested amount for this particular expense.
Description*
For personnel and miles please complete the Law Enforcement Reimbursement Calculation Form to match this reimbursement amount. For supplies, please provide the type and number of supplies purchased. For contractual, please provide the contractor/consultant name and their service. For training, please provide the individuals who attended.
Do you have another expense to request for reimbursement?*

Expense #5

You must enter each expense individually. To add additional expenses, select "yes" when asked if you have another expense to request for reimbursement below. All expenses should mirror the contents of your submitted budget. At the end, you will need to upload all receipts or proof of purchases.
Expense Category*
Strategy*

Compliance checksShoulder tap operationsParty patrolsUnderage drinking presentationsInterdiction activitiesMarijuana-related presentationsMethamphetamine-related presentationsProfessional Development - Pre-approvedOther
Requested Amount*
Please enter the requested amount for this particular expense.
Description*
For personnel and miles please complete the Law Enforcement Reimbursement Calculation Form to match this reimbursement amount. For supplies, please provide the type and number of supplies purchased. For contractual, please provide the contractor/consultant name and their service. For training, please provide the individuals who attended.
Do you have another expense to request for reimbursement?*

Expense #6

You must enter each expense individually. To add additional expenses, select "yes" when asked if you have another expense to request for reimbursement below. All expenses should mirror the contents of your submitted budget. At the end, you will need to upload all receipts or proof of purchases.
Expense Category*
Strategy*

Compliance checksShoulder tap operationsParty patrolsUnderage drinking presentationsInterdiction activitiesMarijuana-related presentationsMethamphetamine-related presentationsProfessional Development - Pre-approvedOther
Requested Amount*
Please enter the requested amount for this particular expense.
Description*
For personnel and miles please complete the Law Enforcement Reimbursement Calculation Form to match this reimbursement amount. For supplies, please provide the type and number of supplies purchased. For contractual, please provide the contractor/consultant name and their service. For training, please provide the individuals who attended.
Do you have another expense to request for reimbursement?*

Expense #7

You must enter each expense individually. To add additional expenses, select "yes" when asked if you have another expense to request for reimbursement below. All expenses should mirror the contents of your submitted budget. At the end, you will need to upload all receipts or proof of purchases.
Expense Category*
Strategy*

Compliance checksShoulder tap operationsParty patrolsUnderage drinking presentationsInterdiction activitiesMarijuana-related presentationsMethamphetamine-related presentationsProfessional Development - Pre-approvedOther
Requested Amount*
Please enter the requested amount for this particular expense.
Description*
For personnel and miles please complete the Law Enforcement Reimbursement Calculation Form to match this reimbursement amount. For supplies, please provide the type and number of supplies purchased. For contractual, please provide the contractor/consultant name and their service. For training, please provide the individuals who attended.
Do you have another expense to request for reimbursement?*

Expense #8

You must enter each expense individually. To add additional expenses, select "yes" when asked if you have another expense to request for reimbursement below. All expenses should mirror the contents of your submitted budget. At the end, you will need to upload all receipts or proof of purchases.
Expense Category*
Strategy*

Compliance checksShoulder tap operationsParty patrolsUnderage drinking presentationsInterdiction activitiesMarijuana-related presentationsMethamphetamine-related presentationsProfessional Development - Pre-approvedOther
Requested Amount*
Please enter the requested amount for this particular expense.
Description*
For personnel and miles please complete the Law Enforcement Reimbursement Calculation Form to match this reimbursement amount. For supplies, please provide the type and number of supplies purchased. For contractual, please provide the contractor/consultant name and their service. For training, please provide the individuals who attended.
Do you have another expense to request for reimbursement?*

Expense #9

You must enter each expense individually. To add additional expenses, select "yes" when asked if you have another expense to request for reimbursement below. All expenses should mirror the contents of your submitted budget. At the end, you will need to upload all receipts or proof of purchases.
Expense Category*
Strategy*

Compliance checksShoulder tap operationsParty patrolsUnderage drinking presentationsInterdiction activitiesMarijuana-related presentationsMethamphetamine-related presentationsProfessional Development - Pre-approvedOther
Requested Amount*
Please enter the requested amount for this particular expense.
Description*
For personnel and miles please complete the Law Enforcement Reimbursement Calculation Form to match this reimbursement amount. For supplies, please provide the type and number of supplies purchased. For contractual, please provide the contractor/consultant name and their service. For training, please provide the individuals who attended.
Do you have another expense to request for reimbursement?*

Expense #10

You must enter each expense individually. To add additional expenses, select "yes" when asked if you have another expense to request for reimbursement below. All expenses should mirror the contents of your submitted budget. At the end, you will need to upload all receipts or proof of purchases.
Expense Category*
Strategy*

Compliance checksShoulder tap operationsParty patrolsUnderage drinking presentationsInterdiction activitiesMarijuana-related presentationsMethamphetamine-related presentationsProfessional Development - Pre-approvedOther
Requested Amount*
Please enter the requested amount for this particular expense.
Description*
For personnel and miles please complete the Law Enforcement Reimbursement Calculation Form to match this reimbursement amount. For supplies, please provide the type and number of supplies purchased. For contractual, please provide the contractor/consultant name and their service. For training, please provide the individuals who attended.
Do you have another expense to request for reimbursement?*

If you have additional expenses to request for reimbursement, please submit a second form.

Complete the Law Enforcement Reimbursement Calculation Form found here. Attach the document to this request along with any receipts for supplies, equipment, or contract purchases. Sign and select submit.
Please upload all the Law Enforcement Reimbursement Calculation Form and required receipts for requested funds:
Total Requested Amount
Please upload all the Law Enforcement Reimbursement Calculation Form and required receipts for requested funds:*

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Cancelof
Signature*
By sending in this form, you certify that the amount detailed represents expenditures of funds for the period covered and for the total project, all made in accordance with the approved budget for the above-named project. You also certify that no grant funds have been used to supplant or lobby.
Should be Empty:

PFS LE Request for Reimbursement Form

Expense #1

Expense #2

Expense #3

Expense #4

Expense #5

Expense #6

Expense #7

Expense #8

Expense #9

Expense #10