Subpart 1.
Application form.
An applicant requesting reimbursement must apply on a form
available on the department's website.
Subp. 2.
Public safety officer
applications.
A public safety officer requesting reimbursement must provide
the following:
A. the officer's
contact information;
B. the
employer's name;
C. for a peace
officer, the officer's license number issued by the Peace Officer Standards and
Training Board;
D. for a qualified
emergency medical service provider, proof of certification under Minnesota
Statutes, section 144E.28, and proof of employment
by a Minnesota-licensed ambulance service;
E. for a firefighter, proof of active status
as a volunteer, paid on-call, part-time, or career firefighter and the agency's
Fire Department Identification Number;
F. an invoice and proof of purchase according
to subpart 5; and
G. any other
information requested by the commissioner as needed to determine eligibility or
to provide reimbursement under this chapter.
Subp. 3.
Agency applications.
An agency requesting reimbursement for an employee must provide
the following:
A. the agency's
name;
B. an employer contact name
and contact information;
C. for all
reimbursement requests for the agency's employees:
(1) the employee's first and last
name;
(2) for a peace officer, the
officer's license number issued by the Peace Officer Standards and Training
Board;
(3) for a qualified
emergency medical service provider, proof of certification under Minnesota
Statutes, section 144E.28, and proof of employment
by a Minnesota-licensed ambulance service;
(4) for a firefighter, proof of active status
as a volunteer, paid on-call, part-time, or career firefighter and the agency's
Fire Department Identification Number; and
(5) an invoice and proof of purchase
according to subpart 5; and
D. any other information requested by the
commissioner as needed to determine eligibility or to provide reimbursement
under this chapter.
Subp.
4.
Unavailable information.
If an applicant cannot provide the information required under
this part, they must explain on the application why they cannot provide the
information.
Subp. 5.
Invoice and proof of purchase required.
A. With the application, an applicant must
provide:
(1) an invoice for each purchased
vest that legibly displays:
(a) the itemized
cost of all items for which reimbursement is being requested; and
(b) the purchase date of the items for which
reimbursement is being requested; and
(2) proof of purchase of the items for which
reimbursement is being requested.
B. A packing slip does not constitute proof
of purchase.
Subp. 6.
Signature required.
An applicant must sign the application by hand or
electronically.
