REIMBURSEMENT CALCULATION - St. Cloud State



TRAVEL EXPENSE REPORT - EMPLOYEES & STUDENTS Employee SEMA4 ID FORMTEXT ????? Employee Name FORMTEXT ????? Work Phone FORMTEXT ????? Home Address (Include City and State) FORMTEXT ?????Destination and Reason for Travel/Advance (example: XYZ Conference, Dallas, TX) FORMTEXT ?????Bargaining Unit FORMTEXT ????? Trip Start Date FORMTEXT ????? Trip Start Time FORMTEXT ????? Trip End Date FORMTEXT ????? Trip End Time FORMTEXT ????? FORMCHECKBOX SHORT TERM ADVANCE FORMCHECKBOX RECURRING ADVANCE FORMCHECKBOX IN-STATE FORMCHECKBOX OUT-OF-STATE FORMCHECKBOX Check if advance was issued for these expenses FORMCHECKBOX FINAL EXPENSE(S) FOR THIS TRIP?DateDaily DescriptionMilesMeals Total Meals (overnight stay)Total Meals (no overnight stay) taxableLodgingTaxi/ ShuttleParkingTotalBLD FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(AA+BA+CA+DA+EA) 0$0.00 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(AB+BB+CB+DB+EB) 0$0.00 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(AC+BC+CC+DC+EC) 0$0.00 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(AD+BD+CD+DD+ED) 0$0.00 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(AE+BE+CE+DE+EE) 0$0.00 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(AF+BF+CF+DF+EF) 0$0.00 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(AG+BG+CG+DG+EG) 0$0.00Total Miles (A) FORMTEXT =(A+B+C+D+E+F+G) 00.00Total MWI/MWO FORMTEXT =(AA+AB+AC+AD+AE+AF+AG) 0$0.00Total MEI/MEO FORMTEXT =(BA+BB+BC+BD+BE+BF+BG) 0$0.00Total LGI/LGO FORMTEXT =(CA+CB+CC+CD+CE+CF+CG) 0$0.00Total TXI/TXO FORMTEXT =(DA+DB+DC+DD+DE+DF+DG) 0$0.00Total PKI/PKO FORMTEXT =(EA+EB+EC+ED+EE+EF+EG) 0$0.00Subtotal (B) FORMTEXT =(AI+BI+CI+DI+EI)/2 $0.00$0.00REIMBURSEMENT CALCULATIONRATESOBJECT CODESIn-StateOut-of-StateInter-national1.Enter rate, miles (A), and amount being claimed at equal to the MinnState rate. Total Miles FORMTEXT =(A+B+C+D+E+F+G) 00.00Rate FORMTEXT $0.600 FORMTEXT =round((A+B+C+D+E+F+G)*(K),2) $0.00$0.00Meal allowance rates, AFSCME, MAPE & Managerial PlanPrivate Auto Mileage211022102510 Standard Cost Areas B - $11.00 L - $13.00 D - $19.00 T - $43.00Travel Expense2120222025202. Enter Meals/Lodging total from above (B). FORMTEXT =round(FI,2)/2 $0.00$0.00 High Cost Metro Area B - $12.00 L - $15.00 D - $23.00 T - $50.00Registration Fee2122222225223. Other Miscellaneous Costs (airfare, conference registration, etc.):Meal allowance rates, MSUAASF non-PDF,MMA, MNA, Commissioners PlanLiving Expenses213022302530 FORMTEXT ????? FORMTEXT $0.00Standard Cost Areas B - $10.00 L - $13.00 D - $19.00 T – $42.00Travel Advance218022802580 FORMTEXT ????? FORMTEXT $0.00High Cost Metro Area B - $12.00 L - $15.00 D - $23.00 T - $50.00Meal w/o Lodging219022902590 FORMTEXT ????? FORMTEXT $0.00Meal allowance rates, MSUAASF PDFACCOUNTING INFORMATIONGrand Total: FORMTEXT =(L+M)/2+N+O+P $0.00$0.00Standard Cost Areas B - $12.50 L - $16.25 D - $23.75 T - $52.50Cost CenterObj CodeAmountHigh Cost Metro Area B - $15.00 L - $18.75 D - $28.75 T - $62.50 FORMTEXT ????? FORMTEXT ???? FORMTEXT $0.00Less Advance issued for this trip: FORMTEXT $0.00Meal allowance rates, IFO FORMTEXT ????? FORMTEXT ???? FORMTEXT $0.00Total amount available for reimbursement to the employee: FORMTEXT =if((Q/2-R)>0,Q/2-R,0.00) 0.0$0.00Standard Cost Areas B - $13.75 L - $16.25 D - $23.75 T - $53.75 FORMTEXT ????? FORMTEXT ???? FORMTEXT $0.00Amount of Advance to be returned by the employee by deduction from paycheck: FORMTEXT =if((Q/2-R)>0,0.00,Q/2-R) $0.00$0.00High Cost Metro Area B - $15.00 L - $18.75 D - $28.75 T - $62.50 FORMTEXT ????? FORMTEXT ???? FORMTEXT $0.00I declare, under penalty of perjury, that this claim is just, correct and that no part of it has been paid or reimbursed by the state of Minnesota or by another party except with respect to any advance amount paid for this trip. I AUTHORIZE PAYROLL DEDUCTION OF ANY SUCH ADVANCE. I have not accepted personal travel benefits. Employee Signature _____________________________________________________________ Date _________________ IRS mileage rate eff. 1/1/24 - 60.0?/mi., eff 1/1/23-12/31/23 - 58.5?/mi. TOTAL: FORMTEXT =UC+UD+UE+UF $0.00$0.00Person Responsible for Cost Center (required if different than supervisor)Printed nameand Signature:__________________________________________________________________Phone: FORMTEXT ?????Date: ________________________ Supervisor Approval: Based on knowledge of necessity for travel and expense and on compliance with all provisions of applicable travel regulations.Name/Signature: ____________________________________________________________SupervisorPhone: FORMTEXT ?????Date: _______________ Business Services Office Use Only Business Expense Trans Number: Trip ID: ................
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