Section J 3D Form CSO011 Court Security Officer CSO Travel Expense Reimbursement.pdf

PDF 69 KB Posted

Attached to
USMS CSO 8(a) Federal contract opportunity
Solicitation number
15M10523RA4700003-0001
Issued by
Department of Justice US Marshals Service

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Form USM-_____ Rev.

Page of

UNCLASSIFIED // FOUO

Form CSO-011 Rev. 09/19 Page of Note: Completed forms containing personally identifiable information (PII) must be encrypted and include the appropriate marking (U/FOUO) in the SUBJECT line of the message prior to dissemination via email.

UNCLASSIFIED // FOUO

U.S. Department of Justice United States Marshals Service Court Security Officer Travel Expense Reimbursement Voucher INSTRUCTIONS: Complete and submit Form CSO-011 to the appropriate supervisor for approval after completion of travel.

1. TRAVELER IDENTIFICATION:

2. DISTRICT ASSIGNMENT:

3. ITINERARY:

Travel Time:

Per Diem is only paid for travel greater than 12 hours Primary Destination:

This location must be listed on the USM-356 Planned Itinerary Section. If it is not listed, the USM-356 must be amended. If traveling to more than one destination all locations must be listed on the USM-356 Planned Itinerary Section.

Highest Class of Travel:

If Premium class of travel is used it MUST be authorized prior to travel by the Director, Deputy Director, or Chief of Finance Reason for Upgrade (Required if Premium or First Class is used):

If Premium class of travel is used it MUST be authorized prior to travel by the Director, Deputy Director, or Chief of Finance

6. EXPENSE SUMMARY:

ITEM DESCRIPTION

AMOUNT

Traveler Paid Air, Train, Bus, etc.

This mode of transportation must be authorized on your USM-356. If it is not checked, the USM-356 must be amended. Receipts (not itineraries) showing the actual expenses paid must be attached. The Federal Travel Regulations and DOJ require travelers to make travel arrangements through the agency Travel Management Center (TMC). Currently CWTSato is the USMS TMC.

Amounts entered on page 2:

Car Rental and Gas POV/Mileage Total Public Transportation - TDY Status State/Local Lodging Taxes Lodging M & I Expenses Parking Other

TOTAL VOUCHER/

AMOUNT TO TRAVELER:

4. TRAVEL PURPOSE:

5. VOUCHER TYPE:

7. APPROVALS: Falsification of an item in an expense account can result in a forfeiture of a claim (28 U.S.C. 2514) and may result in a fine of not more than $10,000 or imprisonment for not more than 5 years or both (18 U.S.C. 287 and 18 U.S.C. 1001).

Traveler Date and Sign Here:

I HEREBY CERTIFY THAT THE TRAVEL UNDERTAKEN IN THIS REIMBURSEMENT VOUCHER IS TRUE TO THE BEST OF MY KNOWLEDGE AND THAT PAYMENT OR CREDIT HAS NOT BEEN RECEIVED BY ME.

Contractor's Approving Official Date and Sign Here:

I HEREBY CERTIFY THAT THE TRAVEL UNDERTAKEN IN THIS REIMBURSEMENT VOUCHER HAS BEEN REVIEWED AND APPROVED AS NECESSARY FOR THE CONDUCT OF USMS CONTRACT BUSINESS.

DAILY EXPENSE REPORT SUMMARY - Enter expenses in categories provided below.

Travel Day State This location must be listed on the USM-356 Planned Itinerary Section. If it is not listed, the USM-356 must be amended.

City/County This location must be listed on the USM-356 Planned Itinerary Section. If it is not listed, the USM-356 must be amended.

Car Rental & Gas This mode of transportation must be authorized on your USM-356. If it is not checked, the USM-356 must be amended. Car rental receipts must be attached and gas expenses greater than $75.00 must be attached. The pre-paid fuel option is not a reimbursable expense.

POV

Mileage This mode of transportation must be authorized on your USM-356. If it is not checked, the USM-356 must be amended. Be sure to include how many miles are being traveled in the optional comments block.

Public Transp.

The type of public transportation must be specified in the optional comments box. If the expense is greater than $75.00, receipts must be attached.

Parking If the parking expense is greater than $75.00, receipts must be attached. Airport parking is a one time charge and cannot be itemized in lieu of receipt.

Other (Comment Req.)

The type of expense must be specified in the optional comments box. If the expense is greater than $75.00, receipts must be attached.

Optional Comments Totals:

Car Rental & Gas This mode of transportation must be authorized on your USM-356. If it is not checked, the USM-356 must be amended. Car rental receipts must be attached and gas expenses greater than $75.00 must be attached. The pre-paid fuel option is not a reimbursable expense.

POV

Mileage This mode of transportation must be authorized on your USM-356. If it is not checked, the USM-356 must be amended. Be sure to include how many miles are being traveled in the optional comments block.

Public Transp.

The type of public transportation must be specified in the optional comments box. If the expense is greater than $75.00, receipts must be attached.

Lodging Taxes If the location is listed on the GSA website as tax exempt, the fee will not be reimbursed and the traveler will need to contact the hotel for a refund.

Lodging This amount should not exceed the lodging per diem on the GSA website. If the amount is over the limit but under 150% of the rate, a signed letter from a supervisor explaining the situation and approving the increase must be included. If the amount is over 150% and less than 300% of the rate allowed, a signed letter from the Chief of Finance must be included if approved.

M & IE

This amount should not exceed the per diem on the GSA website. The first and last day of travel is 75% of the per diem rate.

Parking If the parking expense is greater than $75.00, receipts must be attached. Airport parking is a one time charge and cannot be itemized in lieu of receipt.

Other The type of expense must be specified in the optional comments box. If the expense is greater than $75.00, receipts must be attached.

WEEK 1

WEEK 2

WEEK 3

WEEK 4

WK 5

9.0.0.2.20101008.1.734229

CurrentPage:
PageCount:
ResetButton1:
TravelerName:
TextField1:
District:
This location must be listed on the USM-356 Planned Itinerary Section. If it is not listed, the USM-356 must be amended.:
:
This location must be listed on the USM-356 Planned Itinerary Section. If it is not listed, the USM-356 must be amended. If traveling to more than one destination all locations must be listed on the USM-356 Planned Itinerary Section. :
This location must be listed on the USM-356 Planned Itinerary Section. If it is not listed, the USM-356 must be amended. If traveling to more than one destination all locations must be listed on the USM-356 Planned Itinerary Section. :
PremClass2:
FirstClass2:
This mode of transportation must be authorized on your USM-356. If it is not checked, the USM-356 must be amended. Receipts (not itineraries) showing the actual expenses paid must be attached. The Federal Travel Regulations and DOJ require travelers to make travel arrangements through the agency Travel Management Center (TMC). Currently CWTSato is the USMS TMC.:
This mode of transportation must be authorized on your USM-356. If it is not checked, the USM-356 must be amended. Car rental receipts must be attached and gas expenses greater than $75.00 must be attached. The pre-paid fuel option is not a reimbursable expense.:
This mode of transportation must be authorized on your USM-356. If it is not checked, the USM-356 must be amended. Be sure to include how many miles are being traveled in the optional comments block. :
The type of public transportation must be specified in the optional comments box. If the expense is greater than $75.00, receipts must be attached.:
If the location is listed on the GSA website as tax exempt, the fee will not be reimbursed and the traveler will need to contact the hotel for a refund.:
This amount should not exceed the lodging per diem on the GSA website. If the amount is over the limit but under 150% of the rate, a signed letter from a supervisor explaining the situation and approving the increase must be included. If the amount is over 150% and less than 300% of the rate allowed, a signed letter from the Chief of Finance must be included if approved.:
This amount should not exceed the per diem on the GSA website. The first and last day of travel is 75% of the per diem rate.:
If the parking expense is greater than $75.00, receipts must be attached. Airport parking is a one time charge and cannot be itemized in lieu of receipt. :
The type of expense must be specified in the optional comments box. If the expense is greater than $75.00, receipts must be attached.:
No10Total:
The traveler’s submission date must be the date the traveler submits the voucher to the approving official and may be used to calculate the due date.:
TravelerSig:
OfficialPrinted:
RecdDate:
ApprovedDate:
OfficialSig:
If the location is listed on the GSA website as tax exempt, the fee will not be reimbursed and the traveler will need to contact the hotel for a refund.:
This amount should not exceed the lodging per diem on the GSA website. If the amount is over the limit but under 150% of the rate, a signed letter from a supervisor explaining the situation and approving the increase must be included. If the amount is over 150% and less than 300% of the rate allowed, a signed letter from the Chief of Finance must be included if approved.:
This amount should not exceed the per diem on the GSA website. The first and last day of travel is 75% of the per diem rate.:
Days must match the Trip Begin and End Dates on Section 3 and the Travel Period on the USM-356 (Travel Authorization). If they do not match, the USM-356 must be amended.:
This location must be listed on the USM-356 Planned Itinerary Section. If it is not listed, the USM-356 must be amended.:
This mode of transportation must be authorized on your USM-356. If it is not checked, the USM-356 must be amended. Car rental receipts must be attached and gas expenses greater than $75.00 must be attached. The pre-paid fuel option is not a reimbursable expense.:
This mode of transportation must be authorized on your USM-356. If it is not checked, the USM-356 must be amended. Be sure to include how many miles are being traveled in the optional comments block. :
The type of public transportation must be specified in the optional comments box. If the expense is greater than $75.00, receipts must be attached.:
If the location is listed on the GSA website as tax exempt, the fee will not be reimbursed and the traveler will need to contact the hotel for a refund.:
This amount should not exceed the lodging per diem on the GSA website. If the amount is over the limit but under 150% of the rate, a signed letter from a supervisor explaining the situation and approving the increase must be included. If the amount is over 150% and less than 300% of the rate allowed, a signed letter from the Chief of Finance must be included if approved.:
This amount should not exceed the per diem on the GSA website. The first and last day of travel is 75% of the per diem rate.:
If the parking expense is greater than $75.00, receipts must be attached. Airport parking is a one time charge and cannot be itemized in lieu of receipt. :
The type of expense must be specified in the optional comments box. If the expense is greater than $75.00, receipts must be attached.:
Cell15:

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