{"id":5974,"date":"2022-09-06T15:27:32","date_gmt":"2022-09-06T19:27:32","guid":{"rendered":"https:\/\/housingetc.org\/?page_id=5974"},"modified":"2022-10-06T14:03:35","modified_gmt":"2022-10-06T18:03:35","slug":"hcs-employee-expense-reimbursement-formsdlfkjserlj456786456sdfsdf","status":"publish","type":"page","link":"https:\/\/housingetc.org\/hcs-employee-expense-reimbursement-formsdlfkjserlj456786456sdfsdf\/","title":{"rendered":"HCS Employee Expense Reimbursement Form"},"content":{"rendered":"\n
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\n\n<\/div>\n<\/div>\n<\/div>\n\n\n\n\n\n\n\n <\/title>\n\n <meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" \/>\n\n \n \n <meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n <meta name=\"referrer\" content=\"no-referrer-when-downgrade\">\n <script type=\"text\/javascript\">\n document.addEventListener(\"DOMContentLoaded\", function(){\n const FORM_TIME_START = Math.floor((new Date).getTime()\/1000);\n let formElement = document.getElementById(\"tfa_0\");\n if (null === formElement) {\n formElement = document.getElementById(\"0\");\n }\n let appendJsTimerElement = function(){\n let formTimeDiff = Math.floor((new Date).getTime()\/1000) - FORM_TIME_START;\n let cumulatedTimeElement = document.getElementById(\"tfa_dbCumulatedTime\");\n if (null !== cumulatedTimeElement) {\n let cumulatedTime = parseInt(cumulatedTimeElement.value);\n if (null !== cumulatedTime && cumulatedTime > 0) {\n formTimeDiff += cumulatedTime;\n }\n }\n let jsTimeInput = document.createElement(\"input\");\n jsTimeInput.setAttribute(\"type\", \"hidden\");\n jsTimeInput.setAttribute(\"value\", formTimeDiff.toString());\n jsTimeInput.setAttribute(\"name\", \"tfa_dbElapsedJsTime\");\n jsTimeInput.setAttribute(\"id\", \"tfa_dbElapsedJsTime\");\n jsTimeInput.setAttribute(\"autocomplete\", \"off\");\n if (null !== formElement) {\n formElement.appendChild(jsTimeInput);\n }\n };\n if (null !== formElement) {\n if(formElement.addEventListener){\n formElement.addEventListener('submit', appendJsTimerElement, false);\n } else if(formElement.attachEvent){\n formElement.attachEvent('onsubmit', appendJsTimerElement);\n }\n }\n });\n <\/script>\n\n <link href=\"https:\/\/housingetc.tfaforms.net\/dist\/form-builder\/5.0.0\/wforms-layout.css?v=fcccbda675c087ab2363fdf383cce7d73cd4f1a0\" rel=\"stylesheet\" type=\"text\/css\" \/>\n\n <link href=\"https:\/\/housingetc.tfaforms.net\/uploads\/themes\/theme-21.css\" rel=\"stylesheet\" type=\"text\/css\" \/>\n <link href=\"https:\/\/housingetc.tfaforms.net\/dist\/form-builder\/5.0.0\/wforms-jsonly.css?v=fcccbda675c087ab2363fdf383cce7d73cd4f1a0\" rel=\"alternate stylesheet\" title=\"This stylesheet activated by javascript\" type=\"text\/css\" \/>\n <script type=\"text\/javascript\" src=\"https:\/\/housingetc.tfaforms.net\/wForms\/3.11\/js\/wforms.js?v=fcccbda675c087ab2363fdf383cce7d73cd4f1a0\"><\/script>\n <script type=\"text\/javascript\">\n wFORMS.behaviors.prefill.skip = false;\n <\/script>\n <link rel=\"stylesheet\" type=\"text\/css\" href=\"https:\/\/housingetc.tfaforms.net\/css\/kalendae.css\" \/>\n\t<script type=\"text\/javascript\" src=\"https:\/\/housingetc.tfaforms.net\/js\/kalendae\/kalendae.standalone.min.js\" ><\/script>\n\t<script type=\"text\/javascript\" src=\"https:\/\/housingetc.tfaforms.net\/wForms\/3.11\/js\/wforms_calendar.js\"><\/script>\n <script type=\"text\/javascript\" src=\"https:\/\/housingetc.tfaforms.net\/wForms\/3.11\/js\/localization-en_US.js?v=fcccbda675c087ab2363fdf383cce7d73cd4f1a0\"><\/script>\n\n \n \n<\/head>\n<body class=\"default wFormWebPage\" >\n\n\n <div id=\"tfaContent\">\n <div class=\"wFormContainer\" >\n <div class=\"wFormHeader\"><\/div>\n <style type=\"text\/css\"><\/style><div class=\"\"><div class=\"wForm\" id=\"87-WRPR\" dir=\"ltr\">\n<div class=\"codesection\" id=\"code-87\"><\/div>\n<form method=\"post\" action=\"https:\/\/housingetc.tfaforms.net\/api_v2\/workflow\/processor\" class=\"hintsBelow labelsAbove\" id=\"87\" role=\"form\" enctype=\"multipart\/form-data\">\n<fieldset id=\"tfa_43\" class=\"section\">\n<div id=\"tfa_47\" class=\"section inline group\">\n<div class=\"oneField field-container-D \" id=\"tfa_44-D\">\n<label id=\"tfa_44-L\" class=\"label preField \" for=\"tfa_44\">Date Requested<\/label><br><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_44\" name=\"tfa_44\" value=\"\" autocomplete=\"off\" title=\"Date Requested\" class=\"validate-datecal\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_46-D\">\n<label id=\"tfa_46-L\" class=\"label preField \" for=\"tfa_46\">Payment To:<\/label><br><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_46\" name=\"tfa_46\" value=\"\" title=\"Payment To:\" class=\"\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_49-D\">\n<label id=\"tfa_49-L\" class=\"label preField \" for=\"tfa_49\">Staff Mailing Address:<\/label><br><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_49\" name=\"tfa_49\" value=\"\" title=\"Staff Mailing Address:\" class=\"\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_51-D\">\n<label id=\"tfa_51-L\" class=\"label preField \" for=\"tfa_51\">Reimbursement for:<\/label><br><div class=\"inputWrapper\"><select id=\"tfa_51\" name=\"tfa_51\" title=\"Reimbursement for:\" class=\"calc-reimbursementtype\"><option value=\"\">Please select…<\/option>\n<option value=\"tfa_52\" id=\"tfa_52\" class=\"\">Supplies\/Equipment Purchased<\/option>\n<option value=\"tfa_53\" id=\"tfa_53\" class=\"\">Service Paid<\/option>\n<option value=\"tfa_54\" id=\"tfa_54\" class=\"\">Taxi<\/option>\n<option value=\"tfa_55\" id=\"tfa_55\" class=\"\">Bus<\/option>\n<option value=\"tfa_56\" id=\"tfa_56\" class=\"\">Metro<\/option>\n<option value=\"tfa_57\" id=\"tfa_57\" class=\"\">Parking<\/option>\n<option value=\"tfa_58\" id=\"tfa_58\" class=\"\">Travel\/Mileage Used<\/option>\n<option value=\"tfa_70\" id=\"tfa_70\" class=\"\">Rideshare (Uber\/Lyft)<\/option>\n<option value=\"tfa_59\" id=\"tfa_59\" data-conditionals=\"#tfa_69\" class=\"\">Other<\/option><\/select><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_69-D\">\n<label id=\"tfa_69-L\" class=\"label preField \" for=\"tfa_69\">Other<\/label><br><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_69\" name=\"tfa_69\" value=\"\" data-condition=\"`#tfa_59`\" title=\"Other\" class=\"\"><\/div>\n<\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_71-D\" role=\"radiogroup\" aria-labelledby=\"tfa_71-L\" data-tfa-labelledby=\"-L tfa_71-L\">\n<label id=\"tfa_71-L\" class=\"label preField \">Attachments:<\/label><br><div class=\"inputWrapper\"><span id=\"tfa_71\" class=\"choices vertical \"><span class=\"oneChoice\"><input type=\"radio\" value=\"tfa_76\" class=\"calc-attachment\" id=\"tfa_76\" name=\"tfa_71\" data-conditionals=\"#tfa_75\" aria-labelledby=\"tfa_76-L\" data-tfa-labelledby=\"tfa_71-L tfa_76-L\"><label class=\"label postField\" id=\"tfa_76-L\" for=\"tfa_76\"><span class=\"input-radio-faux\"><\/span>Supplies\/Equipment\/Service<\/label><\/span><span class=\"oneChoice\"><input type=\"radio\" value=\"tfa_77\" class=\"calc-attachment\" id=\"tfa_77\" name=\"tfa_71\" data-conditionals=\"#tfa_82\" aria-labelledby=\"tfa_77-L\" data-tfa-labelledby=\"tfa_71-L tfa_77-L\"><label class=\"label postField\" id=\"tfa_77-L\" for=\"tfa_77\"><span class=\"input-radio-faux\"><\/span>Cab\/Metro\/Bus\/Parking<\/label><\/span><\/span><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_78-D\">\n<label id=\"tfa_78-L\" class=\"label preField \" for=\"tfa_78\">Documentation Upload<\/label><br><div class=\"inputWrapper\"><input type=\"file\" id=\"tfa_78\" name=\"tfa_78\" size=\"\" title=\"Documentation Upload\" class=\"\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_75-D\">\n<label id=\"tfa_75-L\" class=\"label preField \" for=\"tfa_75\">Describe purchase and reason for purchase:<\/label><br><div class=\"inputWrapper\"><textarea id=\"tfa_75\" name=\"tfa_75\" data-condition=\"`#tfa_76`\" title=\"Describe purchase and reason for purchase:\" class=\"validate-float\"><\/textarea><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_82-D\">\n<label id=\"tfa_82-L\" class=\"label preField \" for=\"tfa_82\">Describe purchase of Travel:<\/label><br><div class=\"inputWrapper\"><textarea id=\"tfa_82\" name=\"tfa_82\" placeholder=\"Ie. Used rideshare for TA meeting, also needed supplies from office...\" data-condition=\"`#tfa_77`\" title=\"Describe purchase of Travel:\" class=\"validate-float\"><\/textarea><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_80-D\">\n<label id=\"tfa_80-L\" class=\"label preField \" for=\"tfa_80\">Total Amount Owed<\/label><br><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_80\" name=\"tfa_80\" value=\"\" placeholder=\"$100.50\" title=\"Total Amount Owed\" class=\"validate-float\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_73-D\">\n<label id=\"tfa_73-L\" class=\"label preField \" for=\"tfa_73\">Total Amount Owed in Words<\/label><br><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_73\" name=\"tfa_73\" value=\"\" placeholder=\"One hundred and fifty dollars\" title=\"Total Amount Owed in Words\" class=\"validate-float\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_125-D\">\n<label id=\"tfa_125-L\" class=\"label preField \" for=\"tfa_125\">Banking Information<\/label><br><div class=\"inputWrapper\"><select id=\"tfa_125\" name=\"tfa_125\" title=\"Banking Information\" class=\"calc-bankinginfo\"><option value=\"\">Please select…<\/option>\n<option value=\"tfa_133\" id=\"tfa_133\" class=\"\">Finance has my banking info on file<\/option>\n<option value=\"tfa_134\" id=\"tfa_134\" data-conditionals=\"#tfa_122\" class=\"\">I need to submit my banking info<\/option>\n<option value=\"tfa_135\" id=\"tfa_135\" data-conditionals=\"#tfa_122\" class=\"\">I have updated banking info<\/option><\/select><\/div>\n<\/div>\n<fieldset id=\"tfa_122\" class=\"section\" data-condition=\"`#tfa_134` OR `#tfa_135`\">\n<legend id=\"tfa_122-L\">Bank Information<\/legend>\n<div id=\"tfa_123\" class=\"section inline group\">\n<div class=\"oneField field-container-D \" id=\"tfa_117-D\">\n<label id=\"tfa_117-L\" class=\"label preField reqMark\" for=\"tfa_117\">Account Number<\/label><br><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_117\" name=\"tfa_117\" value=\"\" title=\"Account Number\" class=\"validate-float required\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_115-D\">\n<label id=\"tfa_115-L\" class=\"label preField reqMark\" for=\"tfa_115\">Bank Routing #<\/label><br><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_115\" name=\"tfa_115\" value=\"\" maxlength=\"9\" title=\"Bank Routing #\" class=\"validate-integer required\"><\/div>\n<\/div>\n<\/div>\n<div class=\"htmlSection\" id=\"tfa_121\"><div class=\"htmlContent\" id=\"tfa_121-HTML\"><img decoding=\"async\" src=\"\/\/housingetc.tfaforms.net\/forms\/get_image\/1\/mvWRT8a9h5L5x3uOpnR7LUi8OznInRul9ZpBBjNCf6j2gpYVMYpmUNeKLaw2Y8Z2-Screenshot2022-09-21151229.png\" alt=\"voided check\" style=\"max-width: 100%;\"><\/div><\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_120-D\">\n<label id=\"tfa_120-L\" class=\"label preField reqMark\" for=\"tfa_120\">Upload Voided Check<\/label><br><div class=\"inputWrapper\"><input type=\"file\" aria-required=\"true\" id=\"tfa_120\" name=\"tfa_120\" size=\"\" title=\"Upload Voided Check\" class=\"required\"><\/div>\n<\/div>\n<\/fieldset>\n<\/fieldset>\n<fieldset id=\"tfa_83\" class=\"section\">\n<legend id=\"tfa_83-L\">Employee Signature<\/legend>\n<div class=\"oneField field-container-D \" id=\"tfa_84-D\" role=\"group\" aria-labelledby=\"tfa_84-L\" data-tfa-labelledby=\"-L tfa_84-L\"><div class=\"inputWrapper\"><span id=\"tfa_84\" class=\"choices vertical \"><span class=\"oneChoice\"><input type=\"checkbox\" value=\"tfa_85\" class=\"\" id=\"tfa_85\" name=\"tfa_85\" aria-labelledby=\"tfa_85-L\" data-tfa-labelledby=\"tfa_84-L tfa_85-L\"><label class=\"label postField\" id=\"tfa_85-L\" for=\"tfa_85\"><span class=\"input-checkbox-faux\"><\/span>By submitting this form, I am requesting reimbursement and attest that, to the best of my knowledge, this request is true and accurate.<\/label><\/span><\/span><\/div><\/div>\n<div id=\"tfa_89\" class=\"section inline group\">\n<div class=\"oneField field-container-D \" id=\"tfa_86-D\">\n<label id=\"tfa_86-L\" class=\"label preField \" for=\"tfa_86\">First Name<\/label><br><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_86\" name=\"tfa_86\" value=\"\" title=\"First Name\" class=\"\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_88-D\">\n<label id=\"tfa_88-L\" class=\"label preField \" for=\"tfa_88\">Last Name<\/label><br><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_88\" name=\"tfa_88\" value=\"\" title=\"Last Name\" class=\"\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_91-D\">\n<label id=\"tfa_91-L\" class=\"label preField \" for=\"tfa_91\">Email Address<\/label><br><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_91\" name=\"tfa_91\" value=\"\" title=\"Email Address\" class=\"\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_93-D\">\n<label id=\"tfa_93-L\" class=\"label preField \" for=\"tfa_93\">Program Director<\/label><br><div class=\"inputWrapper\"><select id=\"tfa_93\" name=\"tfa_93\" title=\"Program Director\" class=\"\"><option value=\"\">Please select…<\/option>\n<option value=\"tfa_126\" id=\"tfa_126\" class=\"\">Anita Ballantyne<\/option>\n<option value=\"tfa_127\" id=\"tfa_127\" class=\"\">Caroline Hennessy<\/option>\n<option value=\"tfa_128\" id=\"tfa_128\" class=\"\">Charlena Hamilton<\/option>\n<option value=\"tfa_129\" id=\"tfa_129\" class=\"\">Darren Snell<\/option>\n<option value=\"tfa_131\" id=\"tfa_131\" class=\"\">Jade Tinsley<\/option>\n<option value=\"tfa_132\" id=\"tfa_132\" class=\"\">Juana LaBoy<\/option>\n<option value=\"tfa_94\" id=\"tfa_94\" class=\"\">Marian Siegel<\/option>\n<option value=\"tfa_95\" id=\"tfa_95\" class=\"\">Theresa Hill<\/option>\n<option value=\"tfa_96\" id=\"tfa_96\" class=\"\">Oscar Mitchell<\/option>\n<option value=\"tfa_130\" id=\"tfa_130\" class=\"\">Renee Kelly<\/option>\n<option value=\"tfa_97\" id=\"tfa_97\" class=\"\">Su Cheng<\/option>\n<option value=\"tfa_98\" id=\"tfa_98\" class=\"\">Susan Jacob<\/option><\/select><\/div>\n<\/div>\n<div class=\"oneField field-container-D \" id=\"tfa_105-D\">\n<label id=\"tfa_105-L\" class=\"label preField \" for=\"tfa_105\">Department<\/label><br><div class=\"inputWrapper\"><select id=\"tfa_105\" name=\"tfa_105\" title=\"Department\" class=\"\"><option value=\"\">Please select…<\/option>\n<option value=\"tfa_107\" id=\"tfa_107\" class=\"\">Counseling<\/option>\n<option value=\"tfa_106\" id=\"tfa_106\" class=\"\">HPP<\/option>\n<option value=\"tfa_108\" id=\"tfa_108\" class=\"\">Intake<\/option>\n<option value=\"tfa_110\" id=\"tfa_110\" class=\"\">IZ\/ADU<\/option>\n<option value=\"tfa_112\" id=\"tfa_112\" class=\"\">Department of Health<\/option>\n<option value=\"tfa_111\" id=\"tfa_111\" class=\"\">SSFV<\/option>\n<option value=\"tfa_113\" id=\"tfa_113\" class=\"\">Tenant Services<\/option>\n<option value=\"tfa_109\" id=\"tfa_109\" class=\"\">Training<\/option><\/select><\/div>\n<\/div>\n<\/div>\n<\/fieldset>\n<div class=\"actions\" id=\"87-A\"><input type=\"submit\" data-label=\"Submit\" class=\"primaryAction\" id=\"submit_button\" value=\"Submit\"><\/div>\n<div style=\"clear:both\"><\/div>\n<input type=\"hidden\" value=\"87\" name=\"tfa_dbFormId\" id=\"tfa_dbFormId\"><input type=\"hidden\" value=\"\" name=\"tfa_dbResponseId\" id=\"tfa_dbResponseId\"><input type=\"hidden\" value=\"030de6bf5317e2a24766974306d63062\" name=\"tfa_dbControl\" id=\"tfa_dbControl\"><input type=\"hidden\" value=\"\" name=\"tfa_dbWorkflowSessionUuid\" id=\"tfa_dbWorkflowSessionUuid\"><input type=\"hidden\" value=\"19\" name=\"tfa_dbVersionId\" id=\"tfa_dbVersionId\"><input type=\"hidden\" value=\"\" name=\"tfa_switchedoff\" id=\"tfa_switchedoff\">\n<\/form>\n<\/div><\/div><div class=\"wFormFooter\"><p class=\"supportInfo\"><a target=\"new\" class=\"contactInfoLink\" href=\"https:\/\/housingetc.tfaforms.net\/forms\/help\/87\" data-testid=\"contact-info-link\" rel=\"noopener\">Contact Information<\/a><br><\/p><\/div>\n <p class=\"supportInfo\" >\n <\/p>\n <\/div>\n <\/div>\n\n <script src='https:\/\/housingetc.tfaforms.net\/js\/iframe_message_helper_internal.js?v=2'><\/script>\n\n<\/body>\n<\/html>\n\n","protected":false},"excerpt":{"rendered":"<p>Date Requested Payment To: Staff Mailing Address: Reimbursement for: Please select…Supplies\/Equipment PurchasedService PaidTaxiBusMetroParkingTravel\/Mileage UsedRideshare (Uber\/Lyft)Other Other Attachments: Supplies\/Equipment\/ServiceCab\/Metro\/Bus\/Parking Documentation Upload<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-5974","page","type-page","status-publish","hentry","comments-off"],"acf":[],"_links":{"self":[{"href":"https:\/\/housingetc.org\/wp-json\/wp\/v2\/pages\/5974"}],"collection":[{"href":"https:\/\/housingetc.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/housingetc.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/housingetc.org\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/housingetc.org\/wp-json\/wp\/v2\/comments?post=5974"}],"version-history":[{"count":18,"href":"https:\/\/housingetc.org\/wp-json\/wp\/v2\/pages\/5974\/revisions"}],"predecessor-version":[{"id":6021,"href":"https:\/\/housingetc.org\/wp-json\/wp\/v2\/pages\/5974\/revisions\/6021"}],"wp:attachment":[{"href":"https:\/\/housingetc.org\/wp-json\/wp\/v2\/media?parent=5974"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}