Navajo Nation Claim Form PDF Details

The Navajo Nation Claim Form serves as an essential document within the Financial Services Department of the Navajo Nation, specifically structured for accounts payable tasks. It is meticulously designed to capture a wide range of information, starting with the basics such as the date of the claim, the claimant's name, printed clearly alongside their Social Security Number, and their mailing address. The form is comprehensive, providing spaces for detailing the type of claim being filed, which includes specialized options for councilmen and chapter officers, each with distinct categories such as Board of Election, Labor Commission, Human Rights Commission, among others. Furthermore, it allows for the specification of meeting details, including the purpose, location, and dates, while also accounting for travel by requesting information on the journey made and total miles covered. Claimants are required to disclose the amount claimed, supported by available funds and account numbers, while also affirming the accuracy of their claim with a signature. This form is crucial for the transparent and efficient processing of various claims within the Navajo Nation, from salary advances and retirement payouts to reimbursements for travel and other expenses related to official duties. The process is finalized through approvals by a chairman or president, the controller’s office, and includes provisions for recording advances against payroll, thereby ensuring a well-regulated management of the financial transactions within the Navajo Nation.

QuestionAnswer
Form NameNavajo Nation Claim Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesnavajo nation omb budget forms, navajo nation general claim forms, navajo nation general claim form, navajo nation travel form insurance propose only

Form Preview Example

DATE OF CLAIM

THE NAVAJO NATION

FINANCIAL SERVICES DEPARTMENT

GENERAL CLAIM FORM

ACCOUNTS PAYABLE USE ONLY

AB#

CO#

 

 

NAME OF CLAIMANT

(PRINTED)

SOCIAL SECURITY NUMBER

MAILING ADDRESS

CITY

STATE

ZIP CODE

TYPE OF CLAIM

COUNCILMEN ONLY --- CHECK ONE OF THE FOLLOWING

BOARD OF ELECTION

LABOR COMMISSION HUMAN RIGHTS COMMISSION BLACK MESA REVIEW BOARD

NAVAJO UTAH COMMISSION

NNWATER RIGHTS COMMISSION NN BOARD OF EDUCATION NAVAJO/HOPI LAND COMMISSION COUNCILMEN SALARY ADVANCE

TELECOMMUNICATION REG. COM GOVERNMENT DEVELOPMENT

LOCAL (SEMI-MONTHLY) CHAPTER MEETING OTHER (SPECIFY)

ROUGH ROCK CHAPTER SHIPROCK CHAPTER FORT DEFIANCE CHAPTER COALMINE CHAPTER

 

CHAPTER OFFICERS ONLY – CHECK ONE OF THE FOLLOWING:

 

 

 

 

 

LOCAL CHAPTER MEETING

PLANNING MEETING

AGENCY MEETING

 

 

 

 

 

 

 

ALL OTHERS --- CHECK ONE OF THE FOLLOWING:

 

 

 

 

LAND (FARM) BOARD

DISTRICT GRAZING COMMITTEE

RETIREMENT PAYOUTS

 

EASTERN NAVAJO LAND BOARD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIPTION OF MEETING

LOCATION OF MEETING(S)

DATE(S)

PURPOSE OF MEETING OR ITEMS DISCUSSED

USE BACK IF NECESSARY

TRAVEL INVOLVED

FROM

TO

TO

TOTAL MILES

1.

2.

3.

 

 

 

AMOUNT OF CLAIM

 

 

CONTROLLER’S OFFICE USE ONLY

 

 

 

 

 

 

 

 

 

 

FUNDS

 

 

 

 

 

 

 

 

 

 

 

AVAILABLE

 

 

 

 

 

 

 

 

 

ACCOUNT NO.

 

BY

DATE

 

 

DAYS @ $

 

PER DIEM $

 

 

 

 

 

 

 

 

 

DAYS @ $

 

PER DIEM $

 

 

 

 

 

 

 

 

 

DAYS @ $

 

PER DIEM $

 

 

 

 

 

 

 

 

OTHER EXPENSES (ATTACH RECEIPTS)

 

 

 

 

 

 

 

ADVANCE REQUESTED

 

 

 

 

 

 

 

 

 

LESS DEDUCTIONS

 

 

(

)

 

 

 

 

 

 

 

 

TOTAL

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify that this claim is true and just to the best of my knowledge and that the amounts claimed are due to me and have not been previously paid.

If approved, I request that the check be ready by (time) ____________ on (date) ____________.

I request that the check be (check one)

 

Mailed to me at the address

Picked up by myself

Picked up by person other than myself (name)

 

SIGNATURE OF CLAIMANT

CLAIM APPROVED BY: CHAIRMAN, N.T.C., COMMITTEE CHAIRMAN, CHAPTER PRES., ETC.

CONTROLLER’S APPROVAL

ADVANCES ONLY

 

CURRENT

ADVANCE RECORDED PAYROLL

SIGNATURE

DATE

SIGNATURE

 

 

DATE

ADVANCE BALANCE

BY

DATE

 

 

 

 

 

 

 

 

 

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