Fillable Travel Reimbursement Worksheet (Ohio State University, Columbus)

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Travel Reimbursement Worksheet (Ohio State University, Columbus)

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Travel#________________
Vendor#________________
Arts & Sciences Travel Reimbursement Form Rev 1/28/2015 1 | P a g e
Travel Reimbursement Worksheet
Traveler Name:
Departure City:
Destination City/Cities:
Time of Departure:
Date of Departure:
Date of Return:
Traveler email:
SUMMARY OF TRIP EXPENSES
Actual
Expenses
Pre-Paid
by Dept
Airfare
$ $
Rental Car Contract Vendor? ____Yes ____No
$ $
Personal Vehicle __________miles @ $ per mile
$ $
Conference Registration
$ $
Lodging (populates from below)
$ $
Per Diem (populates from below) ___Full ___Partial ___Receipts ___None
$ $
Other (Misc) Expenses (populates from below)
$ $
Total Pre-Paid expenses
$
Third-Party reimbursement to be deducted (populates from below)
$( )
Cash Advance to be deducted
$( )
Total Actual Expenses (Not Including Pre-Paid by Dept)
$
Amount to Reimburse / Trip Maximum
$
Signature (Note: Applies to guests/visitors only)
I certify that the itemized expenses submitted for reimbursement are actual and reasonable and incurred for a valid OSU business
purpose in accordance with University Policies. In addition, to the best of my knowledge, I have not been reimbursed and will not be
reimbursed for the expenses associated with the payment except as shown above.
Traveler’s Signature:____________________________________________________
Printed Name: _______________________________________Date:______________
Time of Return:
0.545
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signature
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Travel#_________________
Arts & Sciences Travel Reimbursement Form Rev 1/28/2015
2 | P a g e
Per Diem
Meal Allowances are based upon the federal meal and incidental (Per Diem) rates that vary by city location. These rates include incidental expenses (e.g. service tips,
housekeeping, baggage carriers, porters, etc). NO RECEIPTS are needed unless you are reimbursing actual meal expenses or a business meal. Business meals
require an itemized paid receipt with the list of attendees and the business purpose of the meal.
Travelers may be paid at 100% of the Per Diem allowance for the applicable city location or may be reimbursed for less than the Per Diem allowance with a general
description of what was purchased (meal breakdown below) which is considered partial or reduced per diem. Note that the per diem amount is based on daily limits
not meal limits. So if a meal was covered by another source you will subtract 25% of the city per diem for a breakfast that was covered; 25% of the city per diem for a
lunch that was covered; and 50% of the city per diem for a dinner that was covered. The amount remaining is what the traveler is eligible for.
Full meal allowances while on travel status will not be paid if a meal is served on the plane, included in a conference registration fee, built into the hotel room rate, or
replaced by a legitimate business meal. The allowance must be adjusted by deducting the appropriate meal percentage listed below.
Meals provided (on plane / at conference or hotel) Y
___ N ___
**
If
yes,
please
specify
below in the "Additional Information" section and reduce per diem amount.
The university will permit payment of lodging expenses at reasonable, single occupancy or standard business room rates. Payment will be limited to the conference
rate when the hotel/motel is the conference/convention site.
Conference Hotel Rate (if applicable) Y___ N___
Detail
of Meals a
nd Lodging
Daily Per
Diem Rate
B L D
Meal
Total
Lodging
$ $ $ $ $ $
$ $ $ $ $ $
$ $ $ $ $ $
$ $ $ $ $ $
$ $ $ $ $ $
$ $ $ $ $ $
Total
$ $
Detail of Other (Misc) Expenses (taxi/shuttle, rental car gasoline, internet, etc.)
Date
City/State
Description / Reason Amount
$
$
$
$
$
$
Total
$
Detail of Third-Party Reimbursement (if an outside institution/corporation paid or will pay any portion of
the traveler’s expenses)
Date Party Name Description Amount
$
$
$
Total
$
Lodging
Date
City/State
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0.00
0.00
0.00
0.00
0.00
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0.00
0.00
Travel#_________________
Arts & Sciences Travel Reimbursement Form Rev 1/28/2015
3 | P a g e
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Travel Reimbursement Worksheet (Ohio State University, Columbus)

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Completed 28 April 2022

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