One Day One Trial Juror Application For Reimbursement {JD-JA-16}

JD-JA-16 - ONE DAY/ONE TRIAL JUROR APPLICATION FOR REIMBURSEMENT AND REQUEST FOR SOCIAL SECURITY NUMBER. This is a Connecticut Judicial Branch form used by jurors to request reimbursement for eligible out-of-pocket expenses incurred during jury service. Qualified individuals—such as those who are unemployed, work limited hours, or are not compensated by an employer—may claim expenses like mileage, parking, childcare, or family care for up to the first five days of service. The form requires juror identification details, expense reporting, and a signed certification. It may also request a Social Security number for payment processing purposes. C.G.S. § 51-247. www.FormsWorkflow.com