Attachment_22-NEFOP_Observer_Travel_Voucher.pdf

NORTHEAST OBSERVER TRAVEL VOUCHER FORM

NAME: Page _____ of _________

MONITOR/OBSERVER ID: DATE: DATE: DATE: DATE:

PRIMARY PORT: TRIP ID: TRIP ID: TRIP ID: TRIP ID:

From (City/State)

Time of Departure

To (City State)

Time of Arrival

POV (Privately Owned Vehicle) MILEAGE EXPENSES: Mileage Rate: __________

Miles Claimed:

A) Total Mileage (Multiply Total Mileage by Mileage Rate)

MISCELLANEOUS EXPENSES No receipts required for expenses under $75.00

Lodging Tax

Parking

Tolls

Taxis

Other:

B) Total Miscellaneous Expenses:

PER DIEM RATE: Lodging: _________ MI&E: ____________ Day of Departure, Day of Return, MI&E is 75%

Lodging - Receipts Required

MI&E (Meals and Incidentals) - No Receipts Required Allowance for meals not provided. If aboard vessel all day, no MI&E authorized.

Breakfast ______ Lunch ______ Dinner _______

C) Total Per Diem

DAILY EXPENSES SUBTOTALS (A + B + C)

1) TOTAL TRAVEL EXPENSES CLAIMED

No Calls/No Shows (Vessel Name & Date Trip Scheduled) Confirmation Number A) Hourly Salary Rate B) Total Hours Paid Time (Multiply A by B)

Land Hours (Debriefing, Exit Interviews) Date A) Hourly Salary Rate B) Total Hours Paid Time (Multiply A by B)

2) TOTAL PAID TIME CLAIMED

GRAND TOTAL CLAIMED (Add 1 and 2)

Employee's Signature / Date Supervisor's Signature / Date Date Voucher Recived

ADDITIONAL COMMENTS:

Attachment 22

EA133F-17-RP-1824

Sheet1