Thank you for submitting a reimbursement request to the Health Department, as part of the testing of all schools and child care facilities for lead in drinking water. Entering this information will allow the state to reimburse you for replacing fixtures with lead levels that were at or above 4 ppb.
Each school or child care provider should send one reimbursement request once all remediation has been completed, when possible. If you cannot complete this form, or you need to submit by mail, you can use the
Reimbursement Request Document to submit your request. If you need to use the Reimbursement Request Document, please mail your receipts and invoices to:
Vermont Department of Health
Attn: Business Office
PO Box 70
Burlington, VT 05402
If you are requesting reimbursement via this online form, please make sure you will be able to:
- Send a copy of all receipts and invoices electronically (combining them into a single file is recommended, if possible). You will be asked to attach them to the survey when prompted.
- Enter total replacement costs by fixture.
- Identify each tap you are requesting reimbursement for by its initial first draw Lab ID#. You can find the initial first draw Lab ID# by looking up your results on the Results Website and clicking on "Tap Summary Cards".
Note the maximum reimbursement amounts per fixture:
- Public drinking fountains and ice machines: $1,800
- Fixtures used for cooking: $650
- All other fixtures in schools: $350
- All other fixtures in child cares: $400