Travel Time Tracking Sheet - Oregon Department Of Human Services printable pdf download

Travel Time Tracking Sheet

Provider Statement of Understanding:

Payment will not be made for any travel time over the maximum allowed in your CBA unless

required due to an approved exception. No additional charges shall be imposed to either the

employer (recipient), the Department, Area Agency on Aging or any CDDP/Brokerage under this

agreement. Any falsification or concealment of a material fact may be prosecuted under federal

and state laws.

*If for any reason you do not understand this information contact your own legal representation*

 You may only be paid for travel time if you provide authorized services for more than one

employer on the same work day.

 Your travel time must be the most direct and reasonable route. If it takes a significantly

longer amount of time to travel due to unforeseen construction, traffic, or weather incident,

please provide documentation whenever possible.

 If there is a significant break in time to take care of personal business after completing work

for one employer before you go to another employer’s home, you may not be paid for travel

time.

 When filling out the Travel Time Tracking Sheet, the prime number may be found on your

voucher. If your mode of transportation is not a personal vehicle, please write in the mode of

transportation next to the “from address” on each line that it applies.

 Attach additional sheets if necessary.

Key terms to understand:

- A significant break in time is defined as 60 minutes.

- Travel time is traveling from an employer’s care setting to a different employer’s care setting.

Authorized services must have been provided at both locations. Travel is based upon the

mode of transportation taken and is based upon the same workday only.

- Direct and reasonable route means the quickest and safe way to travel from one consumer’s

care setting to the next consumer’s care setting based upon the mode of transportation

taken.

o It is important to understand that you are only paid for time spent traveling to the next

consumer’s care setting. Time spent on personal business will not be paid.

- Personal business includes, but is in no way limited to, the following activities; grocery

shopping, stopping at your home, stopping at a family member or friends house, or stopping

for lunch.

I affirm that the travel time reported on this form is for actual dates and times I traveled directly

between consumer care settings on the same day. The hours I am claiming do not exceed 10% of the

total hours I worked during the pay period. I understand that these travel time sheets will be audited

periodically and that the information reported is true, accurate and complete.

Employee Signature:

Date:

Travel Time Tracking Sheet - Oregon Department Of Human Services