Attachment 10 - Travel Request Form.docx
DOCX document 21 KB Posted
- Solicitation number
- 36C79125R0001
About this file
The document is a Travel Request Form for a specific trip related to the DLS Material Handler Contract (VA-25-00000414) with the Department of Veterans Affairs Veterans Health Administration. The form captures comprehensive travel details including traveler information, trip specifics, transportation arrangements, and anticipated costs. While specific traveler and exact travel dates are not filled in, the form provides a structured template for capturing air travel, ground transportation, lodging, and miscellaneous travel expenses with line items for flight details, rental car information, mileage reimbursement, hotel costs, and total trip expenditures. The form appears designed to track and approve travel expenses for work associated with a material handling service contract at VA warehouses DLS and SDC.
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Text version
Travel Request #1
1. Traveler Information
Full Legal Name
Position Title
Work Site City/State
Work Phone Number
Contract
Work Email
2. Trip Details
Travel Departure Date
Travel Return Date
Trip Location (Full Site Address)
Detailed Trip Purpose
Client Name Requesting Travel
Persons traveling with
| Is Gov. Per Diem being used? |
| ✔ Yes No |
| Per Diem Cost |
| M&IE daily breakdown: |
| M&IE trip total: |
Transportation Mode
3. AIR Travel (please include screenshot of flight when submitting form)
Flight Details Departure Airport: Arrival Airport:
Airline:
Departure Flight Number and Time:
Return Flight Number and Time:
Total Flight Cost: $
Will you be departing and returning to the same airport? ✔ Yes No
| Total Baggage Fees |
| $ |
| Transportation to/from departure airport |
| Drive POV to Airport & Park (enter total mileage & parking) |
| Cost/Details: |
for parking
| Transportation to/from hotel at destination |
| TBD, Estimating Uber/Taxi |
| Cost/Details: |
Transportation to/from work site and other locations while on travel
TBD, Estimating Uber/Taxi
Cost/Details:
Rental Car Details Total Car Cost Estimate $ N/A
Rental Car Gas Estimate: $ N/A
Estimated Tolls: $ N/A
4. POV Travel
| Roundtrip mileage to/from hotel |
| N/A |
| Estimated mileage during travel |
| N/A |
| (including mileage required to/from job site and restaurants) |
| Total Mileage Reimbursement |
| $ N/A |
| (calculated by multiplying total miles by .58) |
| Estimated tolls (if applicable) |
| $ N/A |
5. OTHER Travel (to be used if traveling by a method other than AIR or POV)
Please list all relevant details and cost information here
N/A
6. Lodging Details
Hotel Name
Hotel Address/Phone
Hotel Costs
| Authorized Nightly Hotel Per Diem Rate: $ |
| Total Hotel Cost (including tax): $ |
| Hotel Parking: No |
| Yes ($_ |
| /day) |
| Hotel Parking Total: $ N/A |
| Has the client reserved your room at the time of this request? |
| No |
| Yes |
7. Miscellaneous Travel Costs
Registration/Conference Fees
| No |
| Yes, $ |
Daily Worksite Parking Costs
| No |
| Yes, $ |
8. Total Trip Costs
Total Costs (airfare, lodging, Meals/Per Diem, transportation, fees, etc.)
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File details come from the government source that posted it. Updated .