Fillable NEO A&M COLLEGE Travel Reimbursement Summary (Northeastern Oklahoma A&M College)

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NEO A&M COLLEGE Travel Reimbursement Summary (Northeastern Oklahoma A&M College)

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NEO A&M COLLEGE
Travel Reimbursement Summary
Name ______________________________________CWID: ________________Date:____________________
Department #: ___________________Department Name: ___________________________________________
Purpose of Travel: __________________________________________________________________________
College Vehicle #:________________________or License # of Privately Owned Vehicle__________________
(Destination/Purpose lines for multiple points visited.)
DEPARTURE: FROM____________________________DATE____________________TIME_______________am/pm
Destination/Purpose: 1.____________________________Arrival Date&Time __________am/pm -Departure Date&Time_________am/pm
Destination/Purpose: 2.____________________________Arrival Date&Time __________am/pm -Departure Date&Time_________am/pm
Destination/Purpose: 3.____________________________Arrival Date&Time __________am/pm -Departure Date&Time_________am/pm
RETURN: TO_______________________________DATE___________________TIME________________am/pm
Travel Reimbursement Calculation*
Per Diem:
($55.00 in-state/$61.00 Oklahoma County) $___________
($55.00 – Enid/Garfield County)
Less Meals Provided (___ ) = $__________
($13.75 in-state/$15.25 Oklahoma County/$13.75 Enid/Garfield County)
Per Diem in Lieu of Subsistence:
($65.00 in-state/$71.00 Oklahoma County) $___________
($65.00 – Enid/Garfield County)
Less Meals Provided ( _ ) = $__________
($16.25 in-state/$17.75 Oklahoma County/$16.25 Enid/Garfield County)
Lodging:
(Maximum $94 in-state/$95 Oklahoma City/$94 Enid/Garfield County $__________
Mileage: (Use of Personal Vehicle/$0.33 per mile) $__________
Public Transportation:
(Non-mileage; e.g., railroad, airplane, bus, taxi, etc.) $__________
Miscellaneous Expense:
(e.g., toll, parking, business-related phone calls, registration fees, etc.) $__________
Total Travel Expense Claimed $ ____________
*Out-of-State Rates for per diem and lodging to be determined by GSA Regulations
I, the undersigned, upon oath, do depose and say that I have full knowledge of the above and foregoing account; that said account is just,
correct, due, and according to law; and that the amount claimed after allowing all just credits; is now due and wholly unpaid, and that I
am duly authorized to make the affidavit, so help me God. I also, upon oath, say these expenses were incurred by me while performing
an official college function and that a false application for reimbursement of travel expense will be grounds for termination and criminal
prosecution.
______________________________________________________________________________________________________________
Claimant Signature Date
SEE REVERSE SIDE FOR AUTHORIZED RATES
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NEO A&M COLLEGE
Travel Reimbursement Authorized Rates*
Meals and Incidental Expenses - Maximum Daily Allowance:
In-State Oklahoma County Enid/Garfield Cnty
1 day (24 hours) $55.00 $61.00 $55.00
¾ day (18 hours) 41.25 45.75 41.25
½ day (12 hours) 27.50 30.50 27.50
¼ day (6 hours*) 13.75 15.25 13.75
*Payment for each quarter day or major fraction thereof (more than 3 hours), will
be made at the ¼ day rate show above.
Per Diem in Lieu of Subsistence - Maximum Daily Allowance:
In-State Oklahoma County Enid/Garfield Cnty
1 day (24 hours) $65.00 $71.00 $65.00
¾ day (18 hours) 48.75 53.25 48.75
½ day (12 hours) 32.50 35.50 32.50
¼ day (6 hours*) 16.25 17.75 16.25
*Payment for each quarter day or major fraction thereof (more than 3 hours), will
be made at the ¼ day rate show above.
Mileage Reimbursement/Privately Owned Vehicle: ($.33)
Lodging Reimbursement Rate:
In-State Oklahoma City
Standard $96.00 $104.00
*Out-of-State Rates for per diem and lodging to be determined by GSA Regulations
Visit: www.gsa.gov
Rates effective 10/1/2020-9/30/2021
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NEO A&M COLLEGE Travel Reimbursement Summary (Northeastern Oklahoma A&M College)

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Completed 3 February 2021

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