15. Attachment 7, TRAVEL AUTHORIZATION FORM.pdf
PDF 48 KB Posted
- Solicitation number
- 6973GH-20-R-00137
About this file
This document contains a travel authorization form template for an employee traveling on a federal contract or task. The form requires details on dates of travel, contract number, reason for travel, travel mode, carrier and confirmation information, estimated and actual costs for commercial travel, vehicle rental, privately owned vehicle mileage reimbursement, miscellaneous expenses including metro, taxi and tolls, hotel lodging including per diem rates and estimated and actual costs, and estimated total and actual costs. Relevant federal travel regulations and rate references are provided.
The related federal contract opportunity is a solicitation for Aviation Safety, Technical and Analytical Support Services issued by the Department of Transportation Federal Aviation Administration Aeronautical Center. Solicitation number 6973GH-20-R-00137 includes the solicitation and attachments.
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Text version
TRAVEL AUTHORIZATION FORM
Employee Name: Dates of Travel: thru
Contract / Task Number: 0
Reason for Travel:
Travel Mode:
Confirmation Number:
Carrier Name:
Carrier Phone Number: COMMERCIAL TRAVEL ESTIMATE:
Reservations: ACTUAL COST:
Date
DURATION of TRAVEL STATUS: 1.00 (days)
Daily Rental Rate: $0.00 Rental Tax: $0.00 Pick-Up Date & Time:
Vehicle Class: Compact (compact unless otherwise authorized) Return Date & Time:
Rental Car Gas: $0.00 Rental Days:
Daily Rental Estimate:
Auto Rental Company: VEHICLE RENTAL ESTIMATE:
Reservation: ACTUAL COST:
ESTIMATED MILEAGE
Privately Owned Vehicle (POV) Mileage Reimbursement Rates
POV Reimbursement Rate: $0.545 per mile POV REIMBURSEMENT ESTIMATE:
Mileage Estimate: 0 Actual Mileage: 0 ACTUAL COST:
MISCELLANEOUS EXPENSE
Metro Estimate: $0.00 Actual Expenses: $0.00
Taxi Estimate: $0.00 $0.00 Toll Esimate: $0.00 $0.00 MISCELLANEOUS ESTIMATE:
Other: $0.00 $0.00 ACTUAL COST:
HOTEL / LODGING (per diem rates) Reference AMS Clause 3.3.2-2 Reimbursement for Travel and Subsistence
Hotel Per Diem: Arrival:
Hotel Tax (15%): $0.00 Departure:
Hotel Est Cost Per Night: $0.00 Hotel Nights:
Hotel Parking: $0.00 Daily Estimate: $0.00
Hotel:
Adress:
Phone:
Reservation: HOTEL ESTIMATE:
ACTUAL COST:
CONUS PER DIEM / Meals and Incidental Expenses (M&IE) Foreign Per Diem Rates City/State: _____M&IE: $0.00 Travel Day: 0 $0.00
Travel days (75% M&IE): $0.00 Mission Days: 0 $0.00 M&IE COST:
GOVERNMENT AUTHORIZATION (Travel shall be paid in accordance with FTR.)
Task Manager / POC: ESTIMATED TOTAL COST:
COR: ACTUAL COST:
CO: Difference:
$0.00
$0.00
Federal Travel Regulations (FTR)
$0.00
$0.00
$0.00 $0.00
$0.00
$0.00
$0.00
$0.00
$0.00
VEHICLE RENTAL
$0.00
$0.00
$0.00
Departed (city, st) Arrived (city, st)
$0.00
Date
Notes:
Flight #
Travel Authorization Form
TRANSPORTATION MODE
https://www.gsa.gov/travel/plan-book/transportation-airfare-rates-pov-rates-etc/privately-owned-vehicle-pov-mileage-reimbursement-rates http://www.gsa.gov/portal/content/104877 https://conwrite.faa.gov/CWClauseList.cfm?Show=Num,Title,Text,Pers,UCF,IBR&CatNum=3.3.2 https://www.gsa.gov/portal/category/26429 https://aoprals.state.gov/web920/per_diem.asp http://www.gsa.gov/portal/content/104790
TRAVEL AUTHORIZATION
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