USDA Forest Service
FS-6500-256 (10/2011)
ACTUAL RATE/LUMP SUM METHOD E XPENSE RECORD FOR HOUSE HUNTING TRIP
1. Name:
2. Travel Authorization Number:
3. Traveler(s) Include(s):
Self
4. Check applicable box
Lump Sum Method
Actual Rate Method
Spouse
5. Travel Start Date:
Travel End Date:
6. Travel Itinerary: (Lodging receipts required. Complete only if ‘Actual Rate’ is checked)
Travel
Start
Time
Date
From: City/State
To: City/State
Travel
End
Time
Lodging
Room
Expense
Lodging
Tax
$
$
$
$
$
$
$
$
$
$
$
$
7. Privately Owned Vehicle (POV) Odometer Readings (Include roundtrip mileage between home and the airport, or roundtrip between
home and the new duty station plus house-hunting mileage):
Beginning Odometer Reading:
Ending Odometer Reading:
8. Transportation Expenses: (Receipts required)
Name of Carrier
Ticket Total
$
Check One:
Government Transportation System (GVTS)
$
Government Travel/Personal Credit Card
9. Rental Car Expenses: (Receipts required)
Company Name:
Contract Total: $
Total Gas Receipts: $
Total Miles Driven:
Number of Days:
10. Miscellaneous Expenses: (Receipts required if expense is over $75.00)
Date
Amount
Description (i.e., parking, taxi, shuttle, toll fees, etc.)
$
$
$
11. Remarks:
12. I would like my reimbursement sent to:
My salary address (current Forest Service employees only)
Special address (i.e. travel EFT ):
13. Daytime Phone Number:
14. Current Email Address:
15. Employee Signature:
16. Date:
TMC Fee
$
$
USDA Forest Service
FS-6500-256 (10/2011)
INSTRUCTIONS
Fax completed form to 1-866-689-4968
1. Enter your legal name (first name, middle initial, last name). Nicknames are not accepted.
2. Enter authorization number.
3. Check applicable boxes.
4. Check authorized method of househunting trip. (Lump sum method or actual rate method)
5. Enter the travel start and end date in mm/dd/yy format.
6. Complete this section only if actual rate method is checked. Enter travel data. Dates entered in mm/dd/yy format.
Attach additional sheet(s) if necessary.
7. Enter beginning and ending odometer readings, if applicable.
8. Enter transportation expense data for each traveler (Plane, Train, and Bus), if applicable. Check applicable method
of payment.
9. Enter rental car data, if applicable.
10. Enter data for miscellaneous expense(s) as applicable. Dates entered in mm/dd/yy format.
11. Enter remarks, if applicable. Attach additional sheet(s) if necessary.
12. Check reimbursement method. Enter special address information if applicable.
13. Enter daytime contact number, including area code.
14. Enter current email address.
15. Traveler’s signature.
16. Enter date signed.
Useful information
You will only be reimbursed for authorized expenses. All requested expenses must be authorized and approved prior to
beginning travel.
You must submit receipts for the following authorized expenses:
 Transportation (plane, train, bus, etc.)
 Rental car receipt
 Rental car agreement (i.e. rental car agreement)
 Parking, tolls, etc. (over $75.00)
 Gasoline for rental car
 Lodging receipt showing zero balance (only for actual rate method)
Only authorized individuals names should be shown on receipts to ensure reimbursement.
Attach additional sheet(s) if necessary.