Lost Time Reimbursement

To claim lost time reimbursement for attending official AFSCME Local 668 functions, please click on the "Get Form" button, print the page, complete the information, sign where indicated and submit the original to Local 668 Treasurer, Craig Skone. Do not submit this form directly to AFSCME Council 14, as they will not process lost time claims without the appropriate signatures.

If you are a first-time claimant, or have not yet completed an IRS Form W-4, please do so. Council 14 needs to have one on file for you for payroll processing. You will need to do this only once unless you elect to make changes. Click Here to access a W-4 form in Adobe Acrobat format. Do not use your browser's "Print" button; instead use the Acrobat "Print" button from the row of buttons directly on top of the form. Use your browser's "Back" button to return to this page. If you need to download Acrobat, click on the icon, below. Or, if you prefer, I can send you a copy of the reimbursement form via inter-office mail.

New beginning September 2003: All lost time claimants must also have on file with Council 14 an INS Form I-9, Employment Eligibility Verification. The purpose of this form is to verify the eligibility of individuals for employment to preclude the hiring of aliens who are not authorized to work in the Untied States. Therefore, all requests submitted after September 1, 2003 must have this form completed and sent to me with the lost time claim form. As in the case with IRS Form W-4, this needs to be done only once. Without this form on file, Council 14 will not process your lost time claim. To download and print a form I-9, Click Here. You will be directed to the US Immigration Service website. Use the "back" button on your browser to return to the Local 668 site.

You must complete sections 1 and 2 of the form before submitting it to me. For Section 2, you will complete "List B" and "List C" with the following information. Text in quotation marks should be entered as shown:

List B
List C
Document Title
"Driver's License"
"Social Security Card"
Issuing Authority"MN" (or "WI" if Wisconsin) "US"
Document Number Number on cardNumber on card
Expiration Date Expiration date on cardLeave blank

If you have questions regarding IRS W-4, INS I-9 or the lost time claim form, please contact me at (651) 602-1328, or by e-mail.

- Craig Skone

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