Travel Budget Worksheet
(TA – EXPENSE REPORT)
File Name: Travel Worksheet 30.doc
Request Airline Reimbursement
University Vehicle?
Yes
Yes
TWO PAGES
No
Rev:
Request Travel Advance?
No
Form Date: June 29, 2015
Yes
No TYPE:
Empl ID# :
Employee Name:
Location:
County:
Purpose:
Departure Date:
Time:
Travel Authorization # (TA)
Return Date:
Time:
Expense Report # (ER)
ER ACTUAL
CLAIM
TA ESTIMATE
MILEAGE
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Number of miles (Round Trip) x 44.5 cents/mile
*M & IE Expenses
See Bottom of Form for Rate Schedule.
Receipts Not Required
DEPART
Date:
RETURN
Date:
Sunday
B
L
D
Sunday
Tuesday
B
L
D
Monday
B
L
D
Time:
Day:
Monday
B
L
D
B
L
D
Day:
B
L
D
Tuesday
B
L
D
Time:
Wednesday
Thursday
B
L
D
Wednesday
B
L
D
Thursday
B
B
L
L
D
D
PUBLIC TRANSPORTATION
MUST Include Copy of Itinerary WITH THIS
FORM.
Airfare
Taxi
Bus
Other
P/Card
Friday
Vendor
B
L
D
Friday
B
L
D
Saturday
Saturday
B
L
D
Receipts Required With Claim
LODGING
MUST Submit a Zero Balance Receipt With Claim. (Itemized Receipt)
Note: If Receipt Is Not Zero Balance, Must Include Charge Slip
P/Card
Vendor #
$
$
________ nights @ $________ per night = $________
________ nights @ $________ per night = $________
RENTAL CAR
Receipt and Rental Agreement Required With Claim
P/Card
GAS & OIL
Receipts Required With Claim
P/Card
OTHER i.e., airport parking, telephone, fax, etc
Receipts Required With Claim
$
$
$
P/Card
Conference Registration Fees
It is highly recommended a separate expense report is
created for registration reimbursements.
MUST Include Copy of Registration Form, Agenda, & Meeting Announcement
WITH THIS FORM. Receipt Required With Claim. Originals due with Claim.
P/Card
ER
TOTAL:
* M&IE Expenses
ESTIMATE / ACTUAL CLAIM
(New rates as of 12-1-06)
Time Frame
Leave Before 6 am
Leave Before 11 am, Return After 2 pm
Return After 8 pm, Or Overnight Stay
Meal
Breakfast
Lunch
Dinner
TOTALS
Per Diem Rate (by
$ 9.00
$ 9.00
$11.00 $11.00
$21.00 $24.00
$41.00 $ 44.00
county code)
$10.00 $11.00
$13.00 $14.00
$26.00 $29.00
$49.00 $54.00
$12.00
$15.00
$32.00
$59.00
$13.00
$16.00
$35.00
$64.00