UCSF Department of Surgery - Resident Reimbursement Request Form

Reimbursement requests need to be submitted within 45 days of transaction date or last date of travel to ensure no tax penalty will be incurred. Please note there may be additional eligibility requirements, so please feel free to contact Winnie.Green@ucsf.edu if you have any questions.

Reimbursements are reviewed weekly and are anticipated to be submitted within 2 weeks of submission with all proper documenation. Please ensure that you have reviewed all required receipts/back-up docs to ensure timely reimbursement.

Most reimbursements for the 24-25 Academic Year need to be submitted by Friday, June 6, 2025 in order to be processed before fiscal close. Email Winnie if you have questions about this deadline.

Reimbursement Information

Resident Name*

(Last, First)

Select or enter value

Reimbursement Type*

Select or enter value

Department Approval Obtained*

Please confirm if you obtained via Resident Travel Reimbursement Request Form.

For travel reimbursement, please include all travel receipts, including Connexxus confirmation, if applicable.

Select or enter value

If you have not obtained pre-approval for your travel/meeting reimbursement, we cannot reimburse until that approval is obtained. Please fill out the travel reimbursement request form before submitting receipts here. https://app.smartsheet.com/b/form/9469954a1b4747c0a8931da079155ec1

Note about Fatigue Travel reimbursements

Residents are expected to first attempt to use GME-funded programs at eligible sites whenever possible; if those are impossible to access, you can obtain reimbursement from the Department for fatigue travel. GME has requested that receipts are submitted within 10 days of fatigue travel. Please submit these receipts in a timely manner to ensure reimbursement eligibility.

There are two types of trips that qualify for fatigue travel reimbursement:

Round trip travel that begins from your work site
Round trip that begins from home in anticipation of fatigue after a 24-hour shift

Do not batch together fatigue travel reimbursements. Each request should only encompass one round-trip.

Reimbursement Total*

For the QE application fee, the department will cover $550 for the early registration fee only.

Transaction Date*

Description of reimbursement*

Provide details about the reimbursement such as dates of stay, summary of reimbursements (if multiple items for conferences), and any information you would think is helpful for this request.

Did you attempt to use a GME taxi voucher?*

By selecting an option here you are attesting to the following:

I attest that I diligently searched for a taxi voucher and was not able to obtain one.
I attest that I drove to work, was unable to sleep in a call room and was unable to drive myself home in a safe manner.
I attest that the rideshare service drove me directly from a UCSF Health San Francisco location (Parnassus, Mission Bay, Mount Zion, China Basin) to my verifiable home address.
I understand that tips and gratuities are not reimbursable.

Yes

Additional Notes*

If you were unable to use a GME-funded program, we would like for you to provide some information about your access issue below so that we can communicate this to the GME office (with the hope that they can improve their programs.)

Please also include the ROTATION/SERVICE you were on at the time of request.

Please remember that residents are expected to first attempt to use GME-funded programs at eligible sites whenever possible. More information can be found here: https://meded.ucsf.edu/residents-clinical-fellows/gme-resident-and-fellow-resources/benefits/taxi-voucher-program

Receipts and Back-up Documentation

Upload your receipt and back up documentation as noted below.

Attach Receipt(s)*

A good receipt includes Name of Payee, Transaction Date, and Payment Details (item description, total paid, method of payment). If your receipt does not have all of these things, you will need to submit bank statements as back-up documentation.

Proof of payment (credit card/bank statement)*

Schedule Confirmation with test dates*

dates must be within current AY

List of attendees*

Required for meeting/entertainment reimbursements. If there are more than 5 people, you may submit an attachment, and type "attached" in the box below.

File Attachments*

Ensure all requested documentation is attached before submitting the reimbursement. PDFs are preferred, pictures/screenshots are OK. All information not pertinent to the reimbursement (such as addresses, phone numbers, charges for other items) will be redacted.

Drag and drop files here or

MyExpense Delegation Reminder

Education Office Staff needs to be added as a MyExpense delegate so we can view receipts, prepare, and submit reimbursements on your behalf. Please see instructions below:

1) Login to MyAccess at https://myaccess.ucsf.edu

2) Select MyExpense

3) Select "Profile" (upper righthand corner)

4) Click “Profile Settings”

5) Select "Expense Delegates" from the left hand side of the screen

6) Select "Add" and use the search function to find Winnie Green, Alexi Callen, and Rachelle Bresnahan. If you are submitting receipts for a class dinner, please make sure you also add Sabrina Lum as a delegate.

7) Select check boxes "Can Prepare," "Can Submit," "Can View Receipts"; DO NOT SELECT "Receives Emails"

8) Select check box next to names

9) Click "Save"

Send me a copy of my responses

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