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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

Forms

Chapter:

A

Forms

02-19-2013

Subchapter:

1

Forms

Issuance:

86.3

DCF Form 86-3, Employee Claim for Loss or Damage to Property, and DCF Form 86-3, Attachment A

 

Double click here to view, complete, and print DCF Form 86-3.

 

Double click here to view, complete, and print DCF Form 86-3 Attachment A.

 

WHEN TO USE IT

 

DCF Form 86-3 is a template used by a DCF employee to make a claim for loss or damage to personal property which occurred during the course of performing official duties. DCF Form 86-3 Attachment A is an approval form, completed by the Area Business Office.

 

HOW TO USE IT

 

The employee completes all items on DCF Form 86-3 and enters his or her name on Attachment A, prints out the forms, and submits them to his or her Supervisor. DCF Form 86-3 cannot be processed without complete information. Note in particular Items 14, 14a, and 14b.

 

Claim certified by:

 

•           The employee signs his or her legal signature.

 

•           The employee’s Supervisor signs below to certify the accuracy of the claim.

 

Incident witnessed by:

 

•           The form is signed by any witness or witnesses of the loss or damage to the employee‘s property.

 

The Supervisor then forwards a copy of completed DCF Form 86-3, with supporting documents, if any, to the Area Business Manager who reviews the claim, and, if approved, completes and signs DCF Form 86-3 Attachment A, Statement Supporting a Claim for Loss or Damage to Employee Property, authorizing payment of the claim.

 

Submit completed, signed, and approved DCF Form 86-3, supporting documents, and DCF Form 86-3 Attachment A to the DCF Office of Accounting for claim processing.

 

TIPS FOR COMPLETING THE FORM

 

Complete the forms electronically (they are set up as templates, for ease of completion), or by pen and ink.

 

Attach any pertinent purchase or repair receipts or estimates to the DCF Form 86-3.

 

DISTRIBUTION

 

Original                    -           DCF Office of Accounting

 

Copy                         -           Business Manager

 

Copy                         -           Employee’s Supervisor

 

Copy                         -           Employee