(Revised April 2012)
Kentucky Office of Highway Safety
Division of Highway Safety Programs
REIMBURSMENT CLAIM CHECKLIST FOR CLICK IT OR TICKET MINI-GRANTS
Submit ONE claim at the end of the two-week Click It or Ticket mobilization. Claim should be
submitted by June 30, 2012.
The following documents are required elements of your reimbursement claim:
Reimbursement Claim Form: Two (2) completed forms with an original signature and the
printed name of the project director on each form.
Overtime Worksheets: Two (2) completed worksheets with an original signature and the printed
name of the project director. Each officer should have only one line showing total hours worked for
the month. Allowable employer paid benefits can include FICA (including Medicare), retirement,
and workers compensation.
Activity Reporting Form: One completed form with original signature and the printed name of
Officers Overtime Detail Logs: Two (2) copies of this form are required for each day the officer
works an overtime shift. Logs must include the printed name and signature of both the officer
and the supervisor (officers can not sign log as their own supervisor).