TRAVEL VOUCHER (Temporary Duty Travel)

SECTION A IDENTIFICATION 1. TRAVEL AUTHORIZATION NO.

5. AGENCY ORIGINATING OFFICE

 NUMBER

2. SOCIAL SECURITY NO. 3. NAME (Last)

6. TRAVELER ORIGINATING

 OFFICE NUMBER

11. TRAINING DOCUMENT NO. (For

 Purpose of Travel Code 3 Only)

15. TOTAL NIGHTS LODGING

(First)

7. DATES OF TRAVEL EXPENSES

FROM THRU

Month Day Year Month Day Year

12. OFFICIAL DUTY STATION CITY AND STATE

(Middle Initial) 4. AGENCY 

 CODE

9. RECLAIM

 AMOUNT

 INCLUDED

8. TYPE CLAIM (Indicate one type only)

DM = Domestic

FG = Foreign TDY

OC = Outside Cont. U.S.

GR = Escorted Group

13. RESIDENT CITY AND STATE (If other than official station)

20. FOREIGN ADDRESS 21. TRAVEL EFT ACCOUNT

Zip Code (9)

28. SUMMARY OF SUBSISTENCE

SECTION D CLAIMS

16. NUMBER OF NIGHTS IN APPROVED ACCOMMODATIONS PER THE FIRE SAFETY ACT STANDARDS

State (2)

TDY LOCATION

10. LEAVE TAKEN

Y = Yes N = No

Y = Yes N = No

14. POST APPROVAL INDICATOR

17. SALARY ADDRESS

18. T&A CONTACT POINT

19. SPECIAL ADDRESS

2. (35)

1. (35)

3. City (20)

SECTION B TRAVEL VOUCHER MAILING ADDRESS OPTIONS

SECTION C TRANSPORTATION COSTS

22. METHOD OF 

PAYMENT

23. VENDOR/

CARRIER

24. IDENTIFICATION NUMBER

25. CAR RENTAL

MILES DAYS

TOTALS

Excess Fare (Check if 

Applicable)

$

$

26.

AMOUNT

CNTRY

CODE CITY CODE

Non-contract (Insert

Code)

If payment was made by traveler,

complete Section G on reverse

27. AIRLINE ACCOMMODATIONS:

SECTION E ACCOUNTING CLASSIFICATION

CITY or COUNTY STATE

NO. OF 

 DAYS AMOUNT

$

NFC USE

$

29. PER DIEM

No. of Days [ ]

30. ACTUAL SUBSISTENCE

No. of Days [ ]

31. MILEAGE Rate [ ] Miles [ ]

32. PARKING, TOLLS, ETC.

33. PLANE, BUS, TRAIN

 (Paid by Traveler)

34. UNACCOMPANIED BAGGAGE

35. LOCAL TRANSPORTATION

36. MISCELLANEOUS EXPENSES

37. CAR RENTAL

TOTAL CLAIM

(Blocks 29 thru 37) $

PURPOSE OF TRAVEL CODES

1 = Site visit 9 = Emergency travel

2 = Information meeting 10 = Other travel

14. = Education

11 = Pre-employment travel

13 = Rest and Recuperation

15 = Informal training

3 = Training attendance

4 = Speech or presentation

5 = Conference attendance

7 = Entitlement/home leave

8 = Special mission travel

PERCENTAGE

%

THESE PERCENTAGES MUST EQUAL 100%

PURPOSE CODE ACCOUNTING CLASSIFICATION

46. DISTRIBUTED ACCOUNTING

45. AUTHORIZATION ACCOUNTING

(Check this block if accounting and purpose 

of travel code(s) from travel authorization are

to be charged for the total voucher claim.)

(Check this block distribute total claim from

Section D to the applicable Purpose of Travel

Code and Accounting Classification line.)

SECTION F CERTIFICATIONS

CLAIMANT'S RESPONSIBILITIES AND SIGNATURE. I hereby assign to the United States any rights I may have

against other parties in connection with any reimbursable carrier transportation charges described herein. I have received no

payment for claims shown herein. All travel and reimbursable claims were incurred on official business of the United States

Government. All tickets, coupons, promotional items and credits received in connection with travel claimed on this voucher

have been accounted for as required by 41CFR 301 304 and other regulations. I have reviewed this voucher and certify it

to be correct.

FRAUDULENT CLAIM. Falsification of an item in an expense account will result in a forfeiture of the claim

(28 USC 2514) and may result in a fine of not more than $10,000 or imprisonment of not more than 5 years or both

(18 USC 287; i.d. 1001).

47. CLAIMANT'S SIGNATURE 48. DATE

Month Day Year

49. FINAL VOUCHER 

INDICATOR

Y = Yes N = No

50. APPROVING OFFICER'S SIGNATURE

54. NAME AND TITLE (Last, First, Middle Initial)(Type or Print)

APPROVING OFFICER'S RESPONSIBILITIES AND SIGNATURE. In approving this voucher, I have determined

that (1) Reimbursement is claimed for official travel only; (2) Use of rental car, taxicab, or other special conveyance for which

reimbursement is claimed is to the Government's advantage; and (3) Long distance phone calls and supplies or equipment 

purchased are necessary and in the interest of the Government. Note: To approve long distance phone calls, approving officer

must have written authorization from Agency Head or his/her designee (31 USC 1348).

AGENCY 

CODE

Upon completion and approval, submit original voucher to:

USDA National Finance Center, P.O.Box 60000, New Orleans, LA 70160 

39. TRAVEL ADVANCE AMOUNT OUTSTANDING

40. AMT. OF VOUCHER (Block 38) TO BE APPLIED 

TO OUTSTANDING ADVANCE (Block 39)

41. AMT. OF VOUCHER (Block 38) TO BE APPLIED

TO OUTSTANDING BILL FOR COLLECTION

BILL NO.

42. ADDITIONAL ADVANCE AMOUNT REPAID

(Check or money order attached)

43. REMAINING ADVANCE BALANCE

(Block 39 minus Block 40 and Block 42)

44. NET TO TRAVELER

(Block 38 minus Block 40 and Block 41)

Exception to SF 1012 approved by GSA 11/20/96

FORM AD - 616 (USDA) (Rev. 11/96)

$

AUDITED BY (Examiner's initials) TOTAL DIFFERENCE

51. SOCIAL SECURITY NO. 52. DATE APPROVED

Month Day Year

53. PHONE (Area Code and No.)

55. CONTACT PERSON'S NAME 56. PHONE (Area Code and No.)

c

38.

Rate [ ] Miles [ ]

Rate [ ] Miles [ ]

Rate [ ] Miles [ ]

c

c

c
SOCIAL SECURITY NO. TRAVELER'S NAME

SECTION G SCHEDULE OF EXPENSES AND AMOUNTS CLAIMED

ITINERARY

FROM

DATE (Month/Day)

CITY

STATE

TIME

TO TDY LOCATION

DATE (Month/Day)

CITY

COUNTY

STATE

TIME

PER DIEM

NO. OF DAYS

LODGING

(Receipt Required)

MEALS AND

INCIDENTAL EXPENSES

LESS MEALS

AT GOVERNMENT EXPENSE

PER DIEM AMOUNT

ACTUAL SUBSISTENCE

NO. OF DAYS

LODGING

(Receipt Required)

BREAKFAST

LUNCH

DINNER

M&IE/OTHER

ACTUAL

SUBSISTENCE AMOUNT

MILEAGE

MILES

RATE PER MILE

MILEAGE AMOUNT

PARKING, TOLLS, ETC.

PLANE, BUS, TRAIN

(Paid By Traveler)

UNACCOMPANIED

BAGGAGE

LOCAL

TRANSPORTATION NO. TRIPS

DAILY EXPENSE

MISCELLANEOUS

EXPENSES TELEPHONE CALLS

SUPPLIES, ETC.

CAR RENTAL

(Paid by Traveler)

Receipt and Car Rental

Agreement Required

RENTAL EXPENSE

GASOLINE EXPENSE

REMARKS

PRIVACY ACT NOTICE. The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). The information requested on this form is required under the provisions of 5 USC, Chapter 57 (as

amended) and Executive Orders 11609 of July 22, 1971, and 11012 of March 27, 1962, for the purpose of recording travel expenses incurred by the employee and to claim other entitlements and allowances as prescribed in the 

Federal Travel Regulations (41 CFR 301-304). The information contained in this form will be used by Federal Agency officers and employees who have a need for such information in the performance of their duties. Information will

be transferred to appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal, or regulatory investigations or prosecutions or pursuant to a requirement by GSA or such other agency in connection with the

hiring or firing, or security clearance, or such other investigations of the performance of official duty in Government service. Failure to provide the information required will result in delay or suspension of the employee's claim for reimbursement.

TOTAL CAR RENTAL

TOTAL

MISCELLANEOUS

TOTAL LOCAL

TRANSPORTATION

TOTAL UNACCOMPANIED 

BAGGAGE

TOTAL PLANE, BUS,

TRAIN

TOTAL PARKING

TOTAL MILEAGE

TOTAL MILES

TOTAL ACTUAL

SUBSISTENCE

$

$

$

$

$

$

$

$

$

TOTAL NO. DAYS

TOTAL PER DIEM

TOTAL NO. DAYS

TOTALS

Transfer

these totals to

Section D on

Voucher Front.

If additional

days are

required, use

continuation

sheet

c c c c c c c