B08_R0004_Att_J-4_Travel_Authorization_Form.docx

United States Department of the Interior

INTERIOR BUSINESS CENTER

Washington, DC 20240

Travel Authorization Request Form

Approved travel will be reimbursed in accordance with Chapters 300-304 Federal Travel Regulation (Complete Version) - FTR Amendments through 2012-07 (Note: FTR Amendment 2012-07, Effective 11/6/2012 is the current (Complete Version)). Completion of the form is mandatory. Failure to provide required information may result in delay of a response or disapproval of the request.

TAB to each grey field ( ) and type in the information pertinent to the trip. Send as an e-mail attachment to the Contracting Officer’s Representative for approval prior to making any travel arrangements.

1. Traveler Information

Traveler Name (Last, First, MI)

2. Trip Information

Travel Departure (BEGIN) Date (mm/dd/yy)

(mm/dd/yy)

(mm/dd/yy) Departure Time

3. Expense Breakdown

Estimated Expenses/Cost Breakdown

Additional: $

*Anything other than compact requires justification in Remarks/Additions/Justifications

4. Remarks/Additions/Justifications

Explanation for other anticipated expenses (e.g. taxis, parking, telephone and other allowable miscellaneous expenses):

5. Traveler Certification

I certify that the information given above is accurate. I agree to the terms and conditions set forth in this document as well as the policies governing official travel under the FTR.

Traveler Signature _____________________________________ Date________________

6. Authorizing Official’s Signature

I, recommend this Travel. |_|Yes |_|No (enter name)

Authorizing Official’s Signature Date

Comments:

All travel costs and per diem costs must conform to Federal Travel Regulations (FTR) in effect at the time of travel authorization, including but not limited to daily per diem and lodging rates in effect for the area at the time of the travel. Expenses not in conformity with the FTR will not be reimbursed and should not be submitted. Receipts and other written evidence to support submitted travel expenses over $25.00 will be retained by the contractor for the duration of the contract plus one year, and made available to the CO or COR on request.

Travel not supported by receipts or other evidence will not be reimbursed and should not be submitted. The contractor will state on all invoices that include claims for travel reimbursement that these claims are fully supported by proper documentation, that the documentation is available for audit, and that the claims conform to the FTR.

ID/IQ 140D0418R0004 – Attachment 2 1

ID/IQ 140D0418R0004 – Attachment 2 2 image1.png