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Nevada Nurse Apprentice Program

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testnrhpadmin2023-09-28T18:35:55-08:00

Nurse Apprentice Program ARPA Grant – Travel Request 2023

NAP Travel Requirements:
All travel request forms are due by the 10th of each month for travel that occurred the month prior. Travel costs are reimbursed on a monthly basis.

To qualify for mileage reimbursement the distance must be at least 50 miles one way to the facility and start/end of drive times must be documented. Reimbursement paid at the current GSA rate.

When choosing the meal rate select the option that matches where facility is located:
Clark or Washoe County (Incline Village/Reno/Sparks/Las Vegas/Henderson) = Urban Rate
All other Nevada locations = Rural Rate
Meals provided by the facility do not qualify for meal reimbursement.

You will be required to provide bank information as all travel requests are paid using EFT. Approval can take 3-4 weeks. Payments are typically posted after the 1st of the month following the submission deadline.

Please note: Mileage is reimbursed for the shortest direct route traveled in accordance with 41 CFR 301-2.4. (Airfare will not be reimbursed).

"*" indicates required fields

Step 1 of 5

20%

Personal Information

MM slash DD slash YYYY
*** ATTENTION ***

This form is for submissions for travel taking place in 2023.

Please use the new 2024 Travel Request Form: https://nap.nrhp.org/nurse-apprentice-program-arpa-grant-travel-request-2024/

Name*
Home Address*

Outbound To Facility

Day one of your travel to the facility
MM slash DD slash YYYY
Start Travel Time*
Time left home
:
Facility Arrival Time*
Before clocking in
:
Shortest driving route
2023 Mileage Rate
65.5 cents per mile

Return To Home

Your return trip from facility to home.
MM slash DD slash YYYY
Facility Departure Time*
After clocking out
:
End Travel Time*
Time arrived home
:
Shortest driving route
2023 Mileage Rate
65.5 cents per mile

Additional Reimbursement Requests

Please select any additional reimbursement requests below.
GSA Designation is: URBAN (Washoe County)*
GSA Designation is: URBAN (Clark County)*
GSA Designation is: RURAL*

No Meals Requested - Please click NEXT

Travel Day Meals

*** Meals provided by the facility do not qualify for meal reimbursement. ***

Meals are allowable while on travel status (away from home) during the hours indicated:

Leave home at or before
07:00 = Breakfast
11:00 = Lunch
17:30 = Dinner

Arrive home at or after
09:00 = Breakfast
13:30 = Lunch
19:00 = Dinner

For overnight shifts only: You may select either Late PM or Early AM Lunch to account for your mid-shift meal.

Outbound Meals - RURAL*
Outbound Meals - URBAN*
Return Trip Meals - RURAL*
Return Trip Meals - URBAN*

> > > PROCESSING ERROR < < <

- You selected 2 lunches for the same 24-hour period

PLEASE EDIT YOUR OUTBOUND MEAL SELECTION

> > > PROCESSING ERROR < < <

- You selected 2 lunches for the same 24-hour period

PLEASE EDIT YOUR RETURN MEAL SELECTION

> > > PROCESSING ERROR < < <

- You selected 2 lunches for the same overnight period

PLEASE EDIT YOUR OUTBOUND/RETURN MEAL SELECTION

> > > PROCESSING ERROR < < <

- You selected 2 lunches for the same overnight period

PLEASE EDIT YOUR OUTBOUND/RETURN MEAL SELECTION

I need to claim meals on additional days*
These would be days that you were away from home, but not driving.

Additional Day Meals

Request meal reimbursement for non-driving days here.

*** Meals provided by the facility do not qualify for meal reimbursement. ***

MM slash DD slash YYYY
Non Travel Day 1
RURAL*
URBAN*
URBAN*

MM slash DD slash YYYY
Non Travel Day 2
RURAL
URBAN
URBAN

MM slash DD slash YYYY
Non Travel Day 3
RURAL
URBAN
URBAN

MM slash DD slash YYYY
Non Travel Day 4
RURAL
URBAN
URBAN
This field is hidden when viewing the form

No Lodging Requested - Please click NEXT

Lodging

Lodging paid at GSA rates below:

2023 Lodging Per Diem Rates effective Oct'23
Washoe County (Incline Village/Reno/Sparks) = $125
Clark County (Las Vegas) = $152
Rural Nevada = $107

Receipts are required for lodging

Max. file size: 20 MB.
RECEIPTS ONLY.
Confirmation emails are not eligible for reimbursement.
This is the total on your receipt.
*** GSA MAXIMUM REACHED ***
*** GSA MAXIMUM REACHED ***
*** GSA MAXIMUM REACHED ***

Travel Request Total

After submitting this form you will be redirected to your actual travel request that requires your E Signature.

Bank Information

All payments are made electronically directly to your bank account via EFT.
Bank Account Type*

Section Break

Section Break

Nurse Apprentice Program ARPA Grant Salary Request

MM slash DD slash YYYY
If your facility is not listed, please contact us. An established Nursing Apprentice Program is required.
Requestor(Required)

Nurse Apprentice Name(Required)
Please tell us where your student nurse is attending school so we can add it to the list.

Hours Worked

For those facilities that have both SNF and Acute - please report the hours worked in each department.
Apprentice worked in which type of setting?(Required)
This field is auto-calculated. Enter hours in the adjacent "Acute Hours" and/or "SNF Hours" field(s).
Required for validation
Drop files here or
Max. file size: 20 MB.
    State Facilities Only(Required)
    The Nurse Apprentice Program ARPA Grant provides reimbursement of an hourly rate of $3.00 for the Registered Nurse supervising the Nurse Apprentice. This is included in the hourly reimbursement calculations based on the hours worked by the apprentice.

    If your hospital elects not to receive this reimbursement, please indicate your decision below.

    Have you provided NRHP with a current copy of the student's skills list from their school?(Required)
    Please upload a copy of the recent skills checklist provided by the nurse apprentice's school.
    Drop files here or
    Accepted file types: jpg, pdf, Max. file size: 20 MB.
      MM slash DD slash YYYY
      Enrollment Status(Required)
      By checking this box, you attest that the nurse apprentice is actively enrolled and in good standing in an accredited nursing program. This is a mandatory requirement.
      Clinical Skills Checklist(Required)
      By checking this box, you attest that the nurse apprentice has provided a clinical skills checklist from their nursing program and an updated copy is on file. This is a mandatory requirement.
      This field is hidden when viewing the form
      LPN(Required)
      This field is hidden when viewing the form
      LPN State Facility - OPT IN(Required)
      This field is hidden when viewing the form
      LPN State Facility - OPT OUT(Required)
      This field is hidden when viewing the form
      RN(Required)
      This field is hidden when viewing the form
      RN State Facility - OPT IN(Required)
      This field is hidden when viewing the form
      RN State Facility - OPT OUT(Required)
      This field is hidden when viewing the form
      This field is hidden when viewing the form
      This field is hidden when viewing the form

      FISCAL YEAR CLOSED

      We’re sorry, but requests from the previous fiscal year (ending June 30th, 2023) are no longer eligible for submission.

      Please ensure your request pertains to the current fiscal year. If you have any questions, contact our support team.

      FISCAL YEAR CLOSED

      We’re sorry, but requests from the previous fiscal year (ending June 30th, 2024) are no longer eligible for submission.

      Please ensure your request pertains to the current fiscal year. If you have any questions, contact our support team.

      FISCAL YEAR CLOSED

      We’re sorry, but requests from the previous fiscal year (ending June 30th, 2024) are no longer eligible for submission.

      Please ensure your request pertains to the current fiscal year. If you have any questions, contact our support team.

      FISCAL YEAR CLOSED

      We’re sorry, but requests from the previous fiscal year (ending June 30th, 2024) are no longer eligible for submission.

      Please ensure your request pertains to the current fiscal year. If you have any questions, contact our support team.

      FISCAL YEAR CLOSED

      We’re sorry, but requests from the previous fiscal year (ending June 30th, 2024) are no longer eligible for submission.

      Please ensure your request pertains to the current fiscal year. If you have any questions, contact our support team.

      FISCAL YEAR CLOSED

      We’re sorry, but requests from the previous fiscal year (ending June 30th, 2024) are no longer eligible for submission.

      Please ensure your request pertains to the current fiscal year. If you have any questions, contact our support team.

      FISCAL YEAR CLOSED

      We’re sorry, but requests from the previous fiscal year (ending June 30th, 2024) are no longer eligible for submission.

      Please ensure your request pertains to the current fiscal year. If you have any questions, contact our support team.

      CONTACT US
      Nevada Rural Hospital Partners
      4600 Kietzke Lane, Suite I-209
      Reno, Nevada 89502
      Phone: 775-827-4770  –  Fax: 775-827-0938

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