NRC FORM 64

(05-2021)

U.S. NUCLEAR REGULATORY COMMISSION

TRAVEL VOUCHER 

Schedule of Expenses 

and Amount Claimed

Estimated burden per response to comply with this voluntary collection request 1 hour for NRC Form 64. NRC 

uses the information to authorize payment for official travel. Send comments regarding burden estimate to the 

FOIA, Library, and Information Collections Branch (T-6 A10M), U. S. Nuclear Regulatory Commission, 

Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, and the OMB reviewer at: OMB 

Office of Information and Regulatory Affairs, (3150-0192), Attn: Desk Officer for the Nuclear Regulatory 

Commission, 725 17th Street NW, Washington, DC 20503; e-mail: oira_submission@omb.eop.gov. The NRC 

may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the 

document requesting or requiring the collection displays a currently valid OMB control number. 

APPROVED BY OMB: NO. 3150-0192 EXPIRES: 05/31/2024

NRC FORM 64 (05-2021) Page 1 of 3

1. Name (Last, First, Middle Initial) 2. Office Telephone Number (Include Area Code) (Enter 10 numeric digits)

3. Mailing Address 4. Is this a new address since you last traveled?

Yes No

5. Do you have Direct Deposit?

Yes No

6. Travel Begin Date (MM/DD/YYYY) 7. Travel End Date (MM/DD/YYYY)

8. Expenses Claimed 

(From page 2 - Schedule of expenses and amount claimed)

Expenses Amount Claimed 

Other Expenses

A. Subsistence and 

other expenses (Grand Total from Page 2)

B. Plane, Train, Bus 

(Paid by Traveler) (If applicable)

C. TOTAL CLAIM

9. I CERTIFY THAT THIS VOUCHER IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE 

AND BELIEF AND THAT PAYMENT OR CREDIT HAS NOT BEEN RECEIVED BY ME.

Signature of Traveler

Typed Name of Traveler (Last, First, Middle Initial)

10. THIS VOUCHER IS APPROVED.

Typed Name of Approving Official 

Signature of Approving Official
NRC FORM 64

(05-2021)

U.S. NUCLEAR REGULATORY COMMISSION

TRAVEL VOUCHER (Continued) 

SCHEDULE OF EXPENSES AND AMOUNT CLAIMED

NRC FORM 64 (05-2021) Page 2 of 3

Name (Last, First, Middle Initial) Date (MM/DD/YYYY)

Nature of Expense

Authorized 

Mileage (e.g., .50)

¢

Date Number of Miles Amount Claimed

(Amount to be included in Item 8.C, Page 1) 

GRAND TOTAL - THIS PAGE 
PRIVACY ACT STATEMENT 

NRC Form 64 Travel Voucher, 

Schedule of Expenses and Amount Claimed

Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by Section 3 of the Privacy Act of 1974 (Public Law 93-579), the 

following statement is furnished to individuals who supply information to the U.S. Nuclear Regulatory Commission 

(NRC) on NRC Form 64. This information is maintained in a system of records designated as GSA/GOVT4 - 

Contracted Travel Services Program and described at 74 Federal Register 26700 (June 3, 2009).

1. AUTHORITY: 31 U.S.C. 3511, 3512, and 3523; 5 U.S.C. Chapter 57; and implementing Federal Travel 

Regulations (41 CFR Chapters 300-304).

2. PRINCIPAL PURPOSE(S): To make reimbursement claims for approved and authorized travel expenses, per 

diem, and other change of station expenses

3. ROUTINE USE(S): In addition to the other types of disclosures permitted under subsection of the Privacy Act, 

information from this system of records may be disclosed:

(a.) to another Federal agency, Travel Management Center (TMC), online booking suppliers, and airlines; to 

Federal, State, local or foreign agencies when relevant to a potential or actual civil or criminal violation; 

(b.) To a Federal, State, local, or foreign agency responsible for investigating, prosecuting, enforcing, or carrying 

out a statute, rule, regulation, or order, where agencies become aware of a violation or potential violation of civil or 

criminal law or regulation. 

(c.) To another Federal agency or a court when the Federal Government is party to a judicial proceeding. 

(d.) To a Member of Congress or staff on behalf and at the requests of the individual who is the subject of the 

record. 

(e.) To a Federal agency employee, expert, consultant, or contractor in performing a Federal duty for purposes of 

authorizing, arranging, and/or claiming reimbursement for official travel, including, but not limited to, traveler 

profile information. 

(f.) To a credit card company for billing purposes, including collection of past due amounts. 

(g.) To an expert, consultant, or contractor in the performance of a Federal duty to which the information is 

relevant. 

(h.) To a Federal agency by the contractor in the form of itemized statements or invoices, and reports of all 

transactions, including refunds and adjustments to enable audits of charges to the Federal Government. 

(i.) To a Federal agency in connection with the hiring or retention of an employee; the issuance of a security 

clearance; the reporting of an investigation; the letting of a contract; or the issuance of a grant, license, or other 

benefit to the extent that the information is relevant and necessary to a decision. 

(j.) To an authorized appeal or grievance examiner, formal complaints examiner, equal employment opportunity 

investigator, arbitrator, or other duly authorized official engaged in investigation or settlement of a grievance, 

complaint, or appeal filed by an employee to whom the information pertains. 

(k.) To the Office of Personnel Management (OPM), the Office of Management and Budget (OMB), or the 

Government Accountability Office (GAO) when the information is required for program evaluation purposes. 

(l.) To officials of labor organizations recognized under 5 U.S.C. chapter 71 when relevant and necessary to their 

duties of exclusive representation concerning personnel policies, practices, and matters affecting working 

conditions.
(m.) To a travel services provider for billing and refund purposes. 

(n.) To a carrier or an insurer for settlement of an employee claim for loss of or damage to personal property 

incident to service under 31 U.S.C. 3721, or to a party involved in a tort claim against the Federal Government 

resulting from an accident involving a traveler. 

(o.) To a credit reporting agency or credit bureau, as allowed and authorized by law, for the purpose of adding to a 

credit history file when it has been determined that an individual's account with a creditor with input to the system 

is delinquent. 

(p.) Summary or statistical data from the system with no reference to an identifiable individual may be released 

publicly. 

(q.) To the National Archives and Records Administration (NARA) for records management purposes. 

(r.) To appropriate agencies, entities, and persons when (1) The Agency suspects or has confirmed that the 

security or confidentiality of information in the system of records has been compromised; (2) the Agency has 

determined that as a result of the suspected or confirmed compromise there is a risk of harm to economic or 

property interests, identity theft or fraud, or harm to the security or integrity of this system or other systems or 

programs (whether maintained by GSA or another agency or entity) that rely upon the compromised information; 

and (3) the disclosure made to such agencies, entities, and persons is reasonably necessary to assist in 

connection with GSA's efforts to respond to the suspected or confirmed compromise and prevent, minimize, or 

remedy such harm. For additional detail on these routines uses, please see the GSA/GOVT-4 system notice.

5. NRC CONTACT AND ADDRESS INFORMATION: Chief, Travel Operations Branch, Division of the Controller, Office of 

the Chief Financial Officer, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001.

4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING 

INFORMATION: Disclosure is voluntary. However, if the requested information is not provided, reimbursement may be 

denied.