Expense Reimbursement Request Form (Page 2 of 2) in pdf

Instructions

Internal Revenue Service regulations (1.162.17) require that an employee who is reimbursed by his employer for travel

and entertainment expenses be able to support those expenses as to: a) the amount, b) the time and place of the travel or

use of the facility, c) the business purpose of the expense, and d) the business relationship to the employee of persons

entertained.

GENERAL

1. The form is designed to provide for seven days expenses. The first column is for the first day, etc., until a full week is

ended or the trip is completed.

2. Please enter dates at the head of the appropriate column.

3. Purpose of travel/dates of travel -a phrase indicating the purpose of the trip and dates; e.g., committee meeting.

4. Original receipts are to be attached for all expenditures, including those that are paid by or charged directly to APTA.

Deduct as an advance, expenditures paid by or charged directly to APTA

REIMBURSABLE EXPENSES

5. Airfare or Rail- includes non-local transportation (airfare, rails, etc) not charged to HHS. Receipts must be attached.

Travel insurance is provided to APTA; therefore, additional travel insurance is not reimbursable.

6. Ground Transportation-Personal Auto Mileage-Local Transportation including to and from the airport or train station is

to be entered. Include tips in the total. Personal Automobile mileage is reimbursable at .30 per mile.

7. Car Rental- enter amount for Hertz, etc. Attach original receipts.

8. Hotel Room- attach hotel and motel bills in all cases.

9. Meals-the traveler’s meals only. Meals with guests including employee’s portion are to be included in the Staff

Expense Record” APTA staff members must have receipts for all meal costs over $5.00.

10. Staff Expense record – the names of the guests, association purpose, the place expense occurred, and the amount must

be entered in the Staff expense record box and the daily totals must be entered on the line above.

11. Miscellaneous- include any unusual expenses occurred.

12. Total Expenses-total the daily columns and total column.

13. Travel Advance-enter the amount of the outstanding travel advance(s) applicable to the trip(s).

14. Total Reimbursable-subtract advance from the total expenses. This is the amount to be reimbursed. If the figure is

negative, a check for the amount indicated made payable to Home Health Section should accompany the report.

15. Reimbursement is on the basis of actual hotel expenses (room and tax) plus actual travel costs (plane, train, bus) and

actual local ground transportation. (Airfare reimbursement is based on COACH fare unless only FIRST class is available).

Per Diem is limited to $30.00 per day for breakfast, lunch, and dinner.

16. Any meals provided by the HHS will be deducted from your reimbursement as follows:

Breakfast Deduction $5.00

Lunch Deduction $10.00

Dinner Deduction $15.00

17. Other budgeted or approved expenses should be entered in the misc. section with and explanation below the table.

Completed form should be e-mailed, printed and faxed or mailed along with receipts (copies acceptable if faxed or

e-mailed) to HHS office within 30 days of completing travel or incurring expense.

Expense Reimbursement Request Form Page 2