1. Department:
Insert the traveler's employing department.
2. Traveler's
Name: Insert the name of the traveler.
3. Address:
Insert the traveler's mailing address. This address is necessary to
assure reimbursement checks are mailed to the correct address.
4. Traveler's
SSN: Insert traveler's social security number.
5. Travel
Purpose: Insert the purpose of the trip, conference or speaking
engagement. If this is a combination business/ pleasure trip please
read the appropriate section in the Travel Policies and Procedures regarding
additional requirements.
6. Date
Submitted: Insert the current date.
7. Departure
Date and Time: Insert the departure date and time or the estimated
departure date and time if travel arrangements are not completed.
8. Return
Date and Time: Insert the return date and time or the estimated
return date and time if travel arrangements are not completed.
9. Travel
Destination: Insert the city and state which you traveled or where
you will be traveling.
10. Section
A: Travel Authorization/Anticipated Travel Expenses (Complete only
this section for overnight travel and/or an advance. Please read appropriate
section in the Travel Policy and Procedures regarding specific guidelines.)
a. Estimate: Insert the estimated total travel expenses for each
listed category.
b. Total Estimate: Insert the sum of each estimated travel expense
in the Total Estimate box.
c. Advances: The shaded areas are for business office use only.
11. Signature:
The signature of the traveler's supervisor and/or Unit Budget Manager
is required for this section. If the Unit Budget Manager is not authorized
to sign for the department, the signature of the Senior Administrator's
signature is also required.
12. Section
B: Actual Travel Expenses (Complete this section for reimbursement
after returning from trip. Form should be submitted within no more than
five working days after return date.)
a. Date/Dates: Insert the dates across the first row for each
day in the travel period.
b. Each City: If traveling too only one city please inserts the
city name in the first column only. If more than one city was visited,
list each city under the appropriate date.
c. Number of Miles: If travel was by personal automobile, insert
the number of miles traveled.
d. Mileage Reimbursement: Calculated amount due to traveler by
multiplying the number of miles by the current IRS rate per mile which
is available from the Purchasing Office or from the
Government web site
If this is local travel it should be inserted on the COTC and Cost Share
Local Expense Reimbursement Request Form.
e. Parking/Tolls: Insert all necessary costs of parking and
tolls incurred during travel. Receipts are required for any expenses
over $5.
f. Rental Car/Taxi/Bus: Insert amount paid for rental car, taxi
or bus during travel. Automobile liability insurance is not reimbursable
and should not be purchased when renting a car. Attach the receipt
for reimbursement.
g. Airfare: Insert the amount of airfare, if applicable.
Attach the airline receipt.
h. Hotel: Insert the cost of hotel (room and tax only). Attach
the itemized hotel receipt.
i. Breakfast/Lunch/Dinner: Insert the reimbursable meals
in the appropriate column by day. Alcohol is not a reimbursable expense.
Traveler may use the standard IRS reimbursement rate (See Current
Per Diem Rate if not an ITEMIZED receipt is required.
j. Registration Fees: Insert the registration fee under the
first day traveled and attach receipt.
k. Other: Insert other necessary travel expenses incurred, including
phone calls and tips. Please read the personal phone calls section of
the COTC and Cost Share Travel Policies and Procedures to determine
reimbursable charges.
l. Daily Totals: Sum the total of each column and row. The sum
of the Daily Totals should equal the sum of the rows totaled.
13. Account
Number: Insert the department, cost share, general ledger and type
of expense numbers. Also enter the total amount to be charged to the
department. Use the second column if there are two departments being
charged. The shaded area is for business office use only.
14. Reconciliation:
Total Travel Expense is the amount in the last row in the Totals
column in Section B. Less Advances is the amount of the Total Advances
in Section A. Subtract Total Advance from Total Travel Expense. If the
remaining balance is positive the difference is placed in Amount Due
Traveler and a check will be issued to the traveler. If the remaining
balance is negative the difference is placed in Amount Due COTC and
a check in this amount should be submitted along with this form.
15. Signatures:
The signature of the traveler's supervisor and/or Unit Budget Manager
is required for this section. If the Unit Budget Manager is not authorized
to sign for the department, the signature of the Senior Administrator's
signature is also required.
Central Ohio Technical College
The Ohio State University at Newark
