background shadows

NJ DCF Logo with reverse copy

 

New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date:

Volume:

X

Form

Chapter:

A

Form

3-21-2002

Subchapter:

1

Form

Issuance:

16.103

CP&P Form 16-103, Confirmation Statement on Employee Personal Cellular Telephone use for Work-Related Call

 

Click here to view, print or complete the CP&P Form 16-103

 

WHEN TO USE IT

 

This form is used to certify that all the cellular telephone calls listed on the New Jersey Travel Expense Invoice (AR 54-2) are work-related calls made during the course of official duty as a Division of Child Protection and Permanency employee.

 

In addition, the form is used to request reimbursement for work-related telephone calls made or received on a personal cellular telephone.

 

HOW TO USE IT

 

The employee prepares the CP&P Form 16-103, through use of the on-line form in the computerized Forms Manual. The employee completes the form as follows:

 

•     Enter your name on the first line;

 

•     Sign your name on the second line;

 

•     Enter the office name and cost center code on the third line; and

 

•     Enter the date the Confirmation Statement is completed and submitted.

 

DISTRIBUTION

 

Original          -           DCF Office of Accounting

 

Copy               -           CP&P Employee