Attachment 3 Travel Authorization Form.pdf
PDF 48 KB Posted
- Solicitation number
- 6973GH-25-R-00221
About this file
This is a Travel Authorization Form template used for documenting and tracking employee business travel expenses and obtaining advance authorization from government contracting officials. The form captures comprehensive travel details including employee identification, travel dates, contract/task number assignment, and the business reason for travel.
The form systematically organizes expense categories for reimbursement purposes: transportation mode (commercial flights with carrier details and reservation confirmation), vehicle rental (daily rates, taxes, and rental duration), privately owned vehicle (POV) mileage reimbursement at $0.545 per mile, miscellaneous expenses (metro, taxi, tolls), hotel/lodging per diem rates with arrival/departure dates, and meals and incidental expenses (M&IE) with separate CONUS and foreign per diem rate options. The template includes fields for both estimated and actual costs across all categories, allowing for post-travel reconciliation. Authorization requires approval from three government officials: the Task Manager/Point of Contact, the Contracting Officer's Representative (COR), and the Contracting Officer (CO). All travel must comply with Federal Travel Regulations (FTR) as referenced in AMS Clause 3.3.2-2 for reimbursement policies. The form concludes with summary calculations showing estimated total cost, actual cost, and the variance between the two amounts.
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| 6973GH-25-R-00221.pdf |
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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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