Spreadsheet: 3d3d67ec-dc8b-4bca-bb53-cb87e3353483
Sheet: Travel Reimbursement Form

STATE OF COLORADO
TRAVEL EXPENSE
DEPARTMENT |  |  |  | DIVISION OR AGENCY |  |  |  |  |  | MONTH |  | YEAR
 | TRAVEL |  | Time |  | MILEAGE |  |  | MEALS AND LODGING
Date |  |  | [NAME] | Return | No. | Rate |  |  |  |  |  | 5 |  | Total
 | FROM | TO | am/pm | am/pm | [NAME] | Per | Total | Bkst. | Lunch | Dinner | Lodg. | Inci- | Total | Reimbursable
 |  |  |  |  |  | Mile |  |  |  |  |  | dental |  | Items
 |  |  |  |  |  | 0.5
 |  |  |  |  |  | 0.5
 |  |  |  |  |  | 0.5
 |  |  |  |  |  | 0.5
 |  |  |  |  |  | 0.5
 |  |  |  |  |  | 0.5
 |  |  |  |  |  | 0.5
 |  |  |  |  |  | 0.5
 |  |  |  |  |  | 0.5
 |  |  |  |  |  | 0.5
 |  |  |  |  |  | 0.5
 |  |  |  |  |  | 0.5
TOTALS
MISCELLANEOUS EXPENSE:
(See page two for additional space)
PURPOSE OF TRIP: |  |  |  |  |  |  |  | LESS TRAVEL ADVANCE
 |  |  |  |  |  |  |  |  |  | TOTAL
PERSONS AND AGENCIES CONTACTED:
I certify that the statements in the above schedule are true and just in all respects; that payment of the amounts claimed herein has not and will not be reimbursed to me from any other source(s); that travel performed for which advance/reimbursement is claimed was or will be performed by me while on State business and that no claims are included for expenses of a personal or political nature or for any other expenses not authorized by the Fiscal Rules; and that I actually incurred or paid the operating expenses of the motor vehicle for which reimbursement is claimed on a mileage basis. Further, I hereby authorize the State to deduct from my pay any amount paid to me in excess of my actual incurred expenses.  The signatures on this form constitute approval for use of private auto within the Metro area or a 65-mile radius of the office and that the conditions of the use of private auto have been met and adhered to.
PAYEE SIGNATURE |  |  |  |  |  |  | DATE |  |  |  | EMPL #
PAYEE PRINT NAME AND PHONE NUMBER |  |  |  |  |  |  | MAIL ADDRESS
Reimbursement will by paid State warrant if not checked. |  |  |  |  |  | PLEASE PAY BY ELECTRONIC FUNDS TRANSFER
RECOMMENDED FOR APPROVAL
FISCAL OFFICER |  |  | SUPERVISOR SIGNATURE & PHONE NUMBER |  |  |  |  |  | APPROVING AUTHORITY
ACRONYM | FUND | AGENCY  ID | ORG | APPR | PROGRAM |  | OBJ | SUB | B/S | GBL | RPTG CAT |  | PROJECT | AMOUNT
Shaded areas in coding string to be completed by the District Accounting Office |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL
TRVLEFT.XLS (Revised Jan 2014)
INSTRUCTIONS FOR ELECTRONIC FUND TRANSFER
OF TRAVEL EXPENSE REIMBURSEMENT
 | If an employee would like reimbursement deposited directly to the employee's bank
 | account and the employee has been pre-noted on COFRS, please check the box
 | "Please Pay by Electronic Fund Transfer".
 | If an employee would like to change or add reimbursement deposited directly to
 | the employee's bank account, please contact your District Accounting Office to
 | obtain "Employee's Authorization for Electronic Funds Transfer Form".  The box for
 | "COFRS" - Employee Reimbursement (Travel, etc.) must be checked.  This
 | form and the employee's voided check of deposit slip will be forwarded by the
 | District Accounting Office to the State Controller's Office (SCO) and will
 | be the basis for electronically verifying the "path" to the employee's account.
 | If no bank reject is received in three (3) weeks, future COFRS payments may be
 | paid by EFT if the employee checks the box "Please Pay by Electronic Fund
 | Transfer".
 |  |  |  |  | ADDITIONAL SPACE FOR MISCELLANEOUS EXPENSES, EXPLANATIONS AND COMMENTS:
 |  |  |  |  |  | PLEASE SUBMIT THIS PAGE WITH THE TRAVEL EXPENSE REIMBURSEMENT FORM
STATE OF COLORADO TRAVEL EXPENSE  REIMBURSEMENT FORM
INSTRUCTIONS
TRAVEL
For each date of reimbursable expenses, the facility or city FROM which the travel began and the facility or city  traveled TO must be entered.  Various/Vicinity is not acceptable as Facility names or complete addresses are required for travel within Colorado.  Use page 2 to list complete addresses.  Use of city names is acceptable for travel out-of-state.
TIME DEPART AND TIME RETURN
For each date of reimbursable expenses, the time of departure from the originating facility or city and the time of return are REQUIRED, including the am/pm designation.  These times are used to determine allowable expenses for meal reimbursement.
MILEAGE
1st column is for actual miles driven. 2nd column is for the approved two or four wheel rate. 3rd column is the total to be reimbursed.
MEALS AND LODGING
The per diem rates for travel are in Appendix A, B, and C of Chapter 5 of the State of Colorado Fiscal Rules.  If meals are paid for multiple days, there must be a notation in the lodging box.  It may be the actual cost, direct bill (DB), prepaid (PPD) or other (O)--explain reason marked other (O).  No lunch will be paid for single day travel.
LESS TRAVEL ADVANCE
If a travel advance was given, the amount of the advance must be entered here.  If the advance is more than expenses, attach payment for the difference.
[NAME]
Enter any approved reimbursable expense(s) that are not included in the upper portion of the form.  For any single expense $25 or more, a receipt is required.  Use page two for additional space.  Examples of miscellaneous expenses are business phone calls, parking, tolls, rental cars, gas, cabs, shuttle, and tips (other than for meals), etc.  Use this space for any unusual or additional information that will thoroughly explain why you are requesting payment.
PURPOSE OF TRIP
Briefly explain the purpose of the trip.  If the form covers multiple purposes or trips, list each one separately with associated dates.  Use page two for additional space.
PERSONS AND AGENCIES CONTACTED
Briefly list the agencies and/or people contacted for each specific purpose.
PAYEE INFORMATION
It is important that all employee information be completed to insure the prompt processing of your Travel Expense Reimbursement.  If reimbursement is to be made by EFT (electronic funds transfer), COFRS must be set up in advance and the box next to "Please pay by electronic funds transfer" checked on each submission.
RECOMMENDED FOR APPROVAL
An authorized signature must be given for processing to continue.
COFRS CODING INFORMATION
The appropriate coding string must be entered and must be operating funds.