California form mileage 2025

1. Click ‘Get Form’ to open the California Form Mileage in the editor.
2. Begin by entering your claim number and the injured worker’s name at the top of the form. This information is crucial for processing your reimbursement.
3. In the 'Traveled from' section, input your starting address. Ensure accuracy as this will determine your mileage calculation.
4. Next, fill in the 'Traveled to' field with the name and address of your medical provider. This helps validate your travel expenses.
5. Record the total miles traveled in the designated field. Remember, you can include round trip mileage.
6. Document any parking fees and tolls incurred during your travel. Input these amounts in their respective sections.
7. Finally, calculate and enter the total reimbursement requested based on your mileage and additional costs. Don’t forget to sign and print your name before submission.

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