The Placement Unit have replicated the NHS LSF Travel and Dual Accommodation Expenses (TDAE) form into an online form with calculations.

This will make it easier for you to complete and submit the form, and for the Placement Unit to check the information and receipts before submitting the verified information to NHS BSA.

Section 5 Travel to Placement needs to be completed on a spreadsheet and uploaded to the online form where instructed.

You can upload evidence of cost of Car Hire and Accommodation where indicated.

You can upload evidence of travel costs such as public transport, car parking, toll roads etc from section 5. Please note this needs to be a single document so you will need to prepare this in a for example Word document if you have more than one item.

Please refer to the NHS LSF website for guidance on completing the form:

https://www.nhsbsa.nhs.uk/nhs-learning-support-fund/travel-and-dual-accommodation-expenses

NHS Learning Support Fund (NHS LSF) - Travel and Dual Accommodation Expenses (TDAE) claim form

All TDAE claims must be submitted within six months of the date of the last day of the practice placement for which you are claiming. You must complete all relevant sections of the form or your claim may be delayed.

1. Personal Details - you must complete this section in full.

Unique account reference number allocated to you when you registered for your online NHS Learning Support Fund account - include SSRN
Name (Surname / Forename (s)*
Date of birth*
Term-time Address*

2. Your course and study base

Course year*
Enter the course year you are / were in when you attended this placement
please select one

3.Travel to your normal place of study

How do you normally travel to the above location?*
If your method of travel varies, you should select the option which applies to you the majority of the time.
£
Is your ticket a daily ticket or a travel pass - please select one
£
£
Cost divided by 7
£
Cost divided by 28
£
Cost divided by 364
£
£
daily mileage multiplied by £0.42 plus other incurred daily costs
£
daily mileage multiplied by £0.30

4. Details of your Practice Placement

Do you receive help with your travel to placement via Disabled Students Allowances?*
You cannot claim reimbursement for any travel to placement already covered under DSAs
Full address of your practice placement site*
Were you based at more than one site?
Only tick yes if you will be recording another address on this claim form (an extra box will appear at the end of this section)
How did you normally travel to placement*
£
or if you use a travel pass or season ticket, give the total cost and tick whether this is weekly/monthly/annually below
Travel pass/ season ticket
£
You must provide evidence
Upload evidence of cost of Hire Car here
No File Chosen
File uploads may not work on some mobile devices.
Overseas Placement - If your placement took place outside the UK, the Channel Islands or the Isle of Man, you may be entitled to reimbursement for essential associated costs. Please select yes if this applies
You should detail overseas travel and accommodation costs at sections 5 and 6 of this claim form.
£
Submit evidence of cost via email to PLUStudents@cumbria.ac.uk
£
Submit evidence of cost via email to PLUStudents@cumbria.ac.uk
£
Submit evidence of cost via email to PLUStudents@cumbria.ac.uk

4. Details of your Practice Placement - Additional location

Full address of your practice placement site*
How did you normally travel to placement*
£
or if you use a travel pass or season ticket, give the total cost and tick whether this is weekly/monthly/annually below
Travel pass/ season ticket

5. Your travel to placement

In this section, you are asked to provide details of your journeys to placement.

If you are claiming for public transport or car parking costs, you must include all original tickets with your form. Your university must have sight of these in order to authorise your claim.

Additional mileage/travel costs may be claimed if you have to travel to other practice placement sites, or to patients’ home addresses. You only need to provide daily mileage totals in this column. Please do not provide individual patients’ addresses.

Any community mileage incurred must still exceed the cost of your daily mileage to and from your normal place of study. Community mileage on its own will not be reimbursed if it is not in excess

Please upload the excel spreadsheet to be checked and use totals for section 7
No File Chosen
File uploads may not work on some mobile devices.
Upload evidence of public transport costs and other travel costs ( car parking, tunnel charges, road tolls) from section 5 here. Please use one document for this.
No File Chosen
File uploads may not work on some mobile devices.

6. Dual Accommodation Costs

You should only complete this section if you had to take up separate, secondary accommodation away from your normal term time address in order to attend your placement and you incurred an additional cost as a result. 

Please note: if you stayed in the parental home temporarily in order to attend your placement, you cannot claim for reimbursement of accommodation costs,

Full address of your placement accommodation (This cannot be your normal term time address)
Period claiming for: From
Period claiming for: To
£
Reimbursement for placement costs is capped as follows: £82.50 per night for commercial and £37.50 per night for non-commercial. You must provide evidence of this cost.
Upload evidence of cost of accommodation here
No File Chosen
File uploads may not work on some mobile devices.
Do you live with your parents during term time?
£

7. Summary of costs - Please complete in full

Mode of transport*
please select all that apply
if zero type 0
£
£
£
£
£
£
£
£
£
Total cost of placement travel claim minus total daily travel to University
£
£

8.Student Declaration - You must read, sign and date this section

Please review all information you have provided before completing this declaration. Read this declaration carefully before accepting it. If you choose not to accept it, your funding application will not be processed.

I declare that:

a) I am undertaking a pre-registration programme at a university in England that is eligible for Travel and Dual Accommodation Expenses.

b) I have read and understood the relevant booklet/s and/or any other other information regarding the conditions for claiming Travel and Dual Accommodation Expenses.

c) By signing this declaration I am also aware of the main NHS Learning Support Fund terms and conditions, including the Privacy Notice and Consent to share information clauses, as set out in the declaration I signed when I registered for my NHS LSF account.

d) I confirm that I have enrolled and commenced on my programme of study and am still in active training.

e) I confirm that the expenses claimed were essentially incurred as a result of my attending practice placements and that my normal daily travel to university costs have been deducted.

f) I confirm that I have used the cheapest available transport, where available, to access the practice placement/s.

g) I confirm that, if I have claimed for a private motor vehicle, I have appropriate insurance in place.

h) I understand that the administration of Travel and Dual Accommodation Expenses and responsibility for counter fraud and security management in the NHS are both responsibilities of the NHS Business Services

Authority. I understand that NHSBSA Student Services may share the information on this form with NHS Counter Fraud Authority for the purposes of the prevention, detection, investigation and prosecution of fraud or any other unlawful activity affecting the NHS.

i) I understand and accept that if I fail to give sufficient notice of any change to my bank or building society account details, or provide incorrect details, NHSBSA Student Services cannot take responsibility for payments made to an incorrect account, delayed payments or non-payment of the funding.

j) I understand and accept that the terms and conditions (including rates) of Travel and Dual Accommodation Expenses may change at any time without notice, and the scheme is subject to continued government funding, which may cease at any time without notice.

k) I declare that the information given on this form and in any supporting documents provided is complete and accurate. I understand and accept that if I provide NHSBSA Student Services with false or misleading information, financial support may be refused or withdrawn and I may be liable to prosecution and/or civil proceedings.

Use your mouse or finger to draw your signature above
Date/Time*
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