Staff Development / Wellness Reimbursement Request (SCWA and HSD) v1.2

This is the electronic form used to request reimbursement for Staff Development/Wellness benefits. You must have an electronic receipt to attach to the eForm in order to submit. For more information on eligible/ineligible items, and maximum amounts go to http://sonomacounty.ca.gov/HR/Benefits/Staff-Development/

Staff Development / Wellness Reimbursement Request

* = Required Field

 


Complete all applicable boxes below

Item 1

We prefer that you group recurring purchases as a single item for eForm purposes. For example, monthly gym dues for July 2019 through December 2019 can be entered in Item 1. In the Description enter “Gym dues July 2019-December” in the Date Purchased field “07/01/2019”.

You may enter up to five items on this eForm as long as the receipts are dated in the same fiscal year.

1. Travel out of county?
Attaching the Travel Authorization Form helps indicate to HR approvers, that there were appropriate approvals to evidence that the cost was directly job related and is a non-taxable reimbursement.
Attaching the Travel Authorization Form helps indicate to HR approvers, that there were appropriate approvals to evidence that the cost was directly job related and is a non-taxable reimbursement. Without a Travel Authorization Form, the item will be reimbursed as taxable unless the Employee Description of Expenses clearly explains how the cost is directly related to your job class.

Item 2

2. Travel out of county?
Attaching the Travel Authorization Form helps indicate to HR approvers, that there were appropriate approvals to evidence that the cost was directly job related and is a non-taxable reimbursement.
Attaching the Travel Authorization Form helps indicate to HR approvers, that there were appropriate approvals to evidence that the cost was directly job related and is a non-taxable reimbursement. Without a Travel Authorization Form, the item will be reimbursed as taxable unless the Employee Description of Expenses clearly explains how the cost is directly related to your job class.

Item 3

3. Travel out of county?
Attaching the Travel Authorization Form helps indicate to HR approvers, that there were appropriate approvals to evidence that the cost was directly job related and is a non-taxable reimbursement.
Attaching the Travel Authorization Form helps indicate to HR approvers, that there were appropriate approvals to evidence that the cost was directly job related and is a non-taxable reimbursement. Without a Travel Authorization Form, the item will be reimbursed as taxable unless the Employee Description of Expenses clearly explains how the cost is directly related to your job class.

Item 4

4. Travel out of county?
Attaching the Travel Authorization Form helps indicate to HR approvers, that there were appropriate approvals to evidence that the cost was directly job related and is a non-taxable reimbursement.
Attaching the Travel Authorization Form helps indicate to HR approvers, that there were appropriate approvals to evidence that the cost was directly job related and is a non-taxable reimbursement. Without a Travel Authorization Form, the item will be reimbursed as taxable unless the Employee Description of Expenses clearly explains how the cost is directly related to your job class.

Item 5

5. Travel out of county?
Attaching the Travel Authorization Form helps indicate to HR approvers, that there were appropriate approvals to evidence that the cost was directly job related and is a non-taxable reimbursement.
Attaching the Travel Authorization Form helps indicate to HR approvers, that there were appropriate approvals to evidence that the cost was directly job related and is a non-taxable reimbursement. Without a Travel Authorization Form, the item will be reimbursed as taxable unless the Employee Description of Expenses clearly explains how the cost is directly related to your job class.

Total

By selecting this box I acknowledge that my reimbursement may be subject to income tax as described in the Staff Development/Wellness Benefit Allowance program guidelines found here: http://sonomacounty.ca.gov/HR/Benefits/Staff-Development/

Job related:  

  • CEUs
  • Professional Memberships and Dues
  • Conference
  • Class
  • Course
  • Workshop
  • Travel Expenses
  • Parking Fees
  • Mileage Reimbursement
  • Lodging
  • Meals

Not Job related:

  • Education Conference
  • Class
  • Course
  • Workshop
  • Certifications
  • Travel Expenses
  • Mileage Reimbursement

Wellness Expenses:  

  • Parks Pass
  • County Gym
  • Gym Dues
  • Gym Equipment
  • Sport Entry Fees
  • Sporting Lessons and Equipment
  • Exercise Equipment
  • Diet Management Programs
  • Nutrition Classes
  • Classes for Health Promotion / Fitness
  • Weight Loss Coaching
  • Personal Exercise Coaching
  • Exercise Programs
  • Stress reduction massage or therapy
  • Excercise Videos or DVDs
  • Book/Periodical/Journal
  • Health trackers, step counters and smartwatches such as Fitbits and Apple Watches

Computer and Mobile:

  • Desktops
  • Laptops
  • Cell Phones
  • Smart Phones
  • Tablets
  • Software Applications

(Note:  DSA BU 46 and 47 has a 50% of annual Allowance limit on desktop and laptop computers (no limit on mobile phones)

SCDPDAA and SCPA Educational/Training:

Professional development expenses, i.e. membership dues, conference and training fees, books, legal manuals.

Tool Allowance for Local 39 only:

  • Tools
  • Tool Replacement

Job Required:

  • Professional Licenses
  • Certifications
  • Fee payments related to a Class A or Class B commercial driver license.

Approved emergency preparedness items are limited to the following:

  • Portable generators and emergency power battery systems (equipment costs only)
  • Personal and family pre-configured emergency/disaster/first aid kits (Purchased as a unit)
  • Hand crank radios
  • National Oceanic and Atmospheric (NOAA) weather radios

Specific exclusions include but are not limited to the following:

  • Clothing
  • Disposable batteries
  • Electrical installation
  • Equipment warranties, repair or service costs
  • Extension cords
  • Individual items intended as a “build it yourself” emergency kit
  • Medical supplies
  • Provisions for pets or animals
  • Temporary living structures such as tents or trailers
  • Transportation
  • Two-way radios
  • Water purification systems
  • Weapons

Your total amount requested exceeds your staff development available balance