Voucher Mileage Reimbursement

If you are currently enrolled in the mileage reimbursement program for non-medical transportation services, please complete the fillable PDF and email to sekeller@butlerdd.org. Instructions on completing the reimbursement form are listed below.

  • Enter the month and year at the top of the form.
    1. Enter your name (individual receiving services) and the full address for your home and the day program or employment site name and address.  If you are traveling to more than one destination, please complete a separate form for each destination.
    2. Enter the trip date in the first column and place an X in the column when someone has provided transportation services to pick you up or drop you off at the destination.
    3. The individual or legal guardian must sign the form certifying the trips are accurate and submit the completed form via email or mail to Sarah Keller. Fraudulent trips and/or ride cost will disqualify you from the reimbursement program. 
    4. Reimbursement must be submitted monthly and will not be eligible for payment if the service date exceeds 90 days.  Processing payment may take up to 15 business days.

APP TAXI (UBER / LYFT) REIMBURSEMENT

If you are currently enrolled in the app taxi (Uber/Lyft) reimbursement program for non-medical transportation services, please complete the fillable PDF and email to sekeller@butlerdd.org. Instructions on completing the reimbursement form are listed below.

  1. Enter your name (the BCBDD individual), home address, name of destination, and destination address.
  2. Enter the trip date in the first column.
  3. Enter the trip rate that was paid to Uber or Lyft in the Drop Off Rate and/or the Pick-Up Rate column.  The total cost will automatically calculate if you are entering the trip electronically.  If you are manually entering the rate, the total daily trip cost will have to be written on the form, as well as the grand total for the month.
  4. The individual or legal guardian must sign the form certifying that the trips are accurate and submit the form via email or mail to Sarah Keller. Fraudulent trips and/or ride cost will disqualify you from the reimbursement program.
  5. Reimbursement must be submitted monthly and will not be eligible for payment if the service date exceeds 90 days.  Processing payment may take up to 15 business days.