Attachment C-DFS-AA-15 Voucher Reimbursement.xlsx

XLSX spreadsheet 64 KB Posted

Attached to
TRAVEL MILEAGE REIMBRUSEMENT AND FLEET MANAGEMENT APPLICATION(S)
Solicitation number
ITB-12658
Issued by
Leon County, Florida

About this file

This document is a State of Florida Department of Children and Families (DCF) travel voucher reimbursement form (DFS-AA-15) for tracking and documenting travel expenses for state employees. The form provides detailed guidelines for travel reimbursement, including per diem rates ($80 total, with specific breakdowns for breakfast, lunch, and dinner), mileage reimbursement at 44.5 cents per mile, and a critical lodging restriction of $150 per day for state-sponsored meetings or conferences until July 1, 2018. The form is specifically designed for tracking travel expenses related to Child Protective Investigations (CPI) and Adult Protective Investigations (API), emphasizing that such travel is critical to the department's mission and not feasible to be conducted via teleconference.

The voucher includes comprehensive object codes for in-state and out-of-state travel for both employees and non-employees, covering categories such as general expenses, per diem, meal allowances, mileage, lodging, and airfare. It requires precise documentation, including a nine-digit Personal File (PF) ID, detailed travel purpose, departure and return times, and specific expenses. The form mandates certification by the traveler and supervisor, confirming that the travel was for official state business and necessary for performing official duties. Notably, the document provides specific guidance for preparing travel expense claims, including rules about meal allowances, lodging cost restrictions, and the requirement to justify any expenses that might appear excessive.

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Travel Voucher

STATE OF FLORIDA VOUCHER FOR REIMBURSEMENT OF TRAVELING EXPENSES ---- Children and Families ----Traveler:PF ID:See message on next sheet regarding IMPORTANT REQUIREMENT for PF ID.
Office Address:Headquarters:
City:State:FLZip Code:City of Residence:
Mark One (X):Regular EmployeeOPS EmployeeNon-Employee/Indepen. ContractorFor "Non-Employee" or "Independent Contractor," enter Mailing Address in "Office Address" field, and enter SSN in "PF ID" field.
DateTravel Performed FromPurpose or Reason (Name of Conference)Hour of Departure and Hour of ReturnClass A and B MealsPer Diem or Actual Lodging ExpensesClass C MealsMap Mileage ClaimedVicinity Mileage ClaimedIncidental Expenses
2018Point of Origin to DestinationAmountType

"Date" format (first column) must be "mm/dd/yy." For example, 02/01/16, NOT 2/1/16.

Per diem – $80 Breakfast – $6;
Lunch – $11; Dinner – $19

IMPORTANT NOTICE: Effective until 7/1/2018, daily room rate for lodging associated with meeting, conference or convention organized or sponsored by a state agency may not exceed $150 per day. See "Object Code" sheet (next sheet) for details.

I acknowledge that I can claim full meal allowance allowed by law for a meal (not included in a convention/conference fee) provided by a hotel or airline (CFOP 40-1, para. 5-3e).Mark here (X) to acknowledge that you are entitled to the full meal allowance provided by law, but have voluntarily chosen to claim a lesser amount (CFOP 40-1, para. 5-4e).
If applicable, enter either CPI or API statement, but not both (COPY TEXT from next sheet and PASTE HERE)
Statement of Benefits to the State (Conference or Convention):Column TotalColumn TotalColumn Total0MilesColumn TotalSUMMARY TOTAL
@ 44.5 ₵/mile
0.000.000.000.000.000.00
REGULAR/OPS EMPLOYEE ONLY - LESS CLASS C MEALS(0.00)DO NOT ENTER MINUS (–) SIGN DO NOT ENTER MINUS (–) SIGN
Preparer's Name:Less Advance()
I hereby certify or affirm and declare that this claim for reimbursement is true and correct in every material matter; that the travel expenses were actually incurred by me as necessary in the performance of official duties; that per diem claimed has been appropriately reduced by any meals or lodging included in the convention or conference registration fees claimed by me; and that this voucher conforms in every respect with the rrequirements of Section 112.061, Florida Statutes.Plus Supplemental Page(s)
Phone No:Less non-reimbursable items included on purchasing card()
Net Amount Due Traveler0.00
Traveler's Signature:Title:Date Signed by Traveler:Net Amount Due State0.00Enter Date When Signed by Traveler
Pursuant to Section 112.061(3)(a), Florida Statutes, I hereby certify or affirm that to the best of my knowledge the travel was on official business of the State of Florida and was performed for the purpose(s) stated above.
Supervisor's Name (print):Supervisor's Signature:Title:Date Signed by Supervisor:
Enter Date When Signed by Supervisor
OBJECTAMOUNTOBJECTAMOUNTFOR FISCAL OFFICE USE:Revolving Fund:Advance:Invoice No.:DFS-AA-15, Feb 2018Do Not Print until "Object Codes Total" equals "Net Amount Due"
TR:51SEL:S2626Check No.:Warrant No.:
ORG CODE:2626Check Date:Warrant Date:Object Codes TotalOBJECT CODES listed on next sheet
EO:OCA:2626Agency Voucher No.:Statewide Doc. No.:Transaction Date:
26Agency Voucher No.:0.00
VOUCHER FOR REIMBURSEMENT OF TRAVELING EXPENSESTraveler:Voucher No.:
DateTravel Performed FromPurpose or Reason (Name of Conference)Hour of Departure and Hour of ReturnClass A and B MealsPer Diem or Actual Lodging ExpensesClass C MealsMap Mileage ClaimedVicinity Mileage ClaimedIncidental Expenses
2018Point of Origin to DestinationAmountType
Column TotalColumn TotalColumn Total0MilesColumn TotalSUMMARY TOTALEnter "Summary Total" from this page in the "Plus Supplemental Page(s)" field in the lower right corner on the first page.
DFS-AA-15 (Supplement), Feb 2018@ 44.5 ₵/mile
0.000.000.000.000.000.00

Object Codes TRAVEL RATES: Effective with traveling incurred on 7/1/2006 and thereafter, the following reimbursement rates apply: Per diem – $80; Breakfast – $6; Lunch – $11; Dinner – $19; Mileage – 44.5 cents per mile. This travel form will automatically calculate travel mileage using the current mileage rate.

NINE DIGITS must be entered in the PF ID field. For a 6 digit PF ID, enter 3 leading zeros followed by 6 digit PF ID. For a 7 digit PF ID, enter 2 leading zeros followed by 7 digit PF ID.
Effective until July 1, 2018, costs for lodging associated with a meeting, conference, or convention organized or sponsored in whole or in part by a state agency may not exceed $150 per day. An employee will be required to expend his or her own funds for any daily room rate, including associated taxes, that exceeds the $150 per day restriction.
Each travel voucher or Purchasing Card charge that seeks payment for lodging associated with a meeting, conference, or convention organized or sponsored by a state agency may not exceed the traveler's daily room rate of $150.
A state agency is deemed to have sponsored a meeting, conference, or convention if the agency contributed money for the event. A traveler's registration fee or an agency's membership fee to the organization hosting a conference or convention is not deemed as sponsorship.
A state agency is deemed to have organized a meeting, conference, or convention if the agency is involved in selecting the location or planning the activities to be conducted.
This lodging restriction does not apply to travel activites for conducting business external to the state agency including, but not limit to, audit, investigation, litigation or examination. However, where the daily room rate for these activites exceeds $150, travelers are reminded that the most economical use is required in all situations. Travelers should be prepared to justify costs that appear excessive.
CPI Statement:
CHILD PROTECTIVE INVESTIGATIONS AND SERVICES: "This travel was for the purpose of Child Protective Investigations, pursuant to the requirements of Chapter 39, F.S. and Chapter 65C, F.A.C. It has been designated as critical to the mission of the Department. Due to the nature of this travel, it was not feasible to perform this function by teleconference or other electronic means."
API Statement:
ADULT PROTECTIVE INVESTIGATIONS AND SERVICES: "This travel was for the purpose of Adult Protective Investigations, pursuant to the requirements of Florida Statutes, Chapter 415. It has been designated as critical to the mission of the Department. Due to the nature of this travel, it was not feasible to perform this function by teleconference or other electronic means."

TRAVEL OBJECT CODES (as of 8/26/2015). Use the following DCF travel object codes when completing travel vouchers.

IN STATE TRAVEL – DCF EmployeesOUT OF STATE TRAVEL – DCF EmployeesTRAVEL ADVANCES
261000 – General262000 – General269000 – Travel Advances
261038 – Car Rental/Fuel262034 – Car Rental/Fuel
261049 – Incidental Expenses262038 – Incidental Expenses
261100 – Per Diem262100 – Per DiemREGISTRATION/TRAINING – EMPLOYEE
261200 – Meal Allowance262200 – Meal AllowanceREIMBURSEMENT
261300 – Mile Allowance262300 – Mile Allowance461400 – Fees – Registration/Training –
261400 – Lodging262400 – LodgingEmployee Reimbursement
261500 – Airfare262500 – Airfare
IN STATE TRAVEL – NON EmployeesOUT OF STATE TRAVEL – NON Employees
261054 – General262039 – General
261104 – Per Diem262104 – Per Diem
261204 – Meal Allowance262204 – Meal Allowance
261304 – Mile Allowance262304 – Mile Allowance
261409 – Lodging262404 – Lodging
261514 – Airfare262506 – Airfare

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