The NJ Police Chief Magazine Volume 24, Number 6 | Page 17

Continued from previous page If your municipality is interested in applying for the reimbursable costs for hepatitis B vaccinations, the following will be required in a letter format: 1) The name of the municipality, along with address, contact person and phone number on municipal stationary. 2) The total amount expended for the inoculations in each of the individuals specified below (Number #3). 3) The total composition of the municipality’s emergency services personnel including: a. Number of volunteer emergency medical technicians - ambulance. b. Number of volunteer firefighters. c. Number of paid EMTs - ambulance. d. Number of paid firefighters. e. Number of police officers. 4) The total amount sought for reimbursement including actual costs incurred for inoculations of each individual specified in number 3, and the cost of fees for professional medical services for administration of the vaccine. 5) A statement certifying that the reimbursement applied for represents actual costs incurred and that such costs are not eligible for coverage and have not been covered through any other source, nor has the cost for each individual been reimbursed by these funds in the past. Please send your application to: Mr. Howard Cohen New Jersey Department of Health, Division of Epidemiology, Environmental and Occupation Health Office of Assistant Commissioner Post Office Box 369 Trenton, New Jersey 08625-0369 All applications must be postmarked by October 3, 2018. If you have any questions regarding this matter, please call me at [phone] or reach me by email at [email protected] Sincerely, Howard J. Cohen Contract Administrator 16