By including a per diem amount in the letter, the parties will not have to execute another payoff letter if the termination date. It typically details the principal balance, interest due as of that date, per diem, any late fees, etc.Loans (the "Payoff Sum"). You will be required to fill out a "Defendant Request Form". This request will be forwarded to the presiding Judge for review. All employees and supervisors who are responsible for completing evaluations shall receive training on this policy and the Employee Performance Evaluation form. This chapter discusses policy for individuals whose income must be considered when completing a Family-Related Medicaid eligibility determination. Travel and per diem. 2,507. 812. 4,651. 8,000.