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Get Meal Allowance Form

Attachment B Overtime Meal Allowance Claim Form Complete and submit this form no later than October 14 2005 to Public Employees Federation Contract Administration Department P. O. Box 12414 Albany New York 12212-2414 Directions This claim form must be completed by retirees in order to receive payment for overtime meal allowances as described in the Overtime Meal Allowance Claim Procedure. The retiree must attach Required Documentation as described in Section G of the Claim Procedure for each overtime meal allowance claimed* Name Social Security Number Home Address City State Zip Home Phone Email Department/Agency Location/Unit Title Grade Identify your pass days during the period April 1999 to August 2000 Please complete the chart below for each date that you seek payment for an overtime meal allowance. If you have more meal allowance claims please complete additional forms. Date Worked Month/Day/Year Time Work Began i*e* 7 00 p*m* Ended i*e* 7 00 p*m* Total Hours Worked i*e* 11 Regular Work Day Yes or No Pass Day Number of Allowances One or Two Total Overtime Meal Allowances Your social security number is required since overtime meal allowances are payroll transactions and taxable. The retiree must attach Required Documentation as described in Section G of the Claim Procedure for each overtime meal allowance claimed* Name Social Security Number Home Address City State Zip Home Phone Email Department/Agency Location/Unit Title Grade Identify your pass days during the period April 1999 to August 2000 Please complete the chart below for each date that you seek payment for an overtime meal allowance. If you have more meal allowance claims please complete additional forms. Date Worked Month/Day/Year Time Work Began i*e* 7 00 p*m* Ended i*e* 7 00 p*m* Total Hours Worked i*e* 11 Regular Work Day Yes or No Pass Day Number of Allowances One or Two Total Overtime Meal Allowances Your social security number is required since overtime meal allowances are payroll transactions and taxable.

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  • allowances
  • transactions
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