TRAVEL CONFIRMATION FORM PLEASE COMPLETE THIS CONFIRMATION FORM AND EMAIL TO: MII@usdoj.gov 30 days before you plan to travel to your test site location. COURSE NAME: CPT CODING – AAPC TESTING PROJECT CODE: CMS1 ACCOUNTING CODE: 0E407207 Name: Social Security # (needed for travel expenses reimbursement process) Title: Agency/Department: Office Address: Office Telephone: Office Fax: Email Address: Emergency Contact: (Name and Phone Number) DCN # (please leave blank - to be completed by MII staff) Testing Date and Location: (City and State) Roundtrip Is this a one day mileage total trip from home to Travel Y/N Testing Site * If your travel requires an overnight stay/lodging, you will need to contact the MII for additional information before reserving a room. (803) 705-5145/5077 MII@usdoj.gov ** Travel Authorization/Confirmation Form & Travel Voucher: Your Social Security Account Number (SSN) is solicited under the authority of the Internal Revenue Code (26 U.S.C. 6011(b) and 6109) and E.O. 9397, November 22, 1943, for use as a taxpayer and/or employee identification number; disclosure is MANDATORY on vouchers claiming travel payment or reimbursement which is, or may be taxable income. Failure to furnish the information requested may result in total or partial denial of the amount claimed.
Pages to are hidden for
"aapc travel confirmation form"Please download to view full document