Fillable Sema4 Employee Expense Report (Page 2 of 2) in pdf

EMPLOYEE EXPENSE REPORT (Instructions)

DO NOT PAY RELOCATION EXPENSES ON THIS FORM.

Earn Code

See form FI-00568 Relocation Expense Report. Relocation expenses must be

Description

In State

Out of State

Description

In State

Out of State

sent to Minnesota Management & Budget, Statewide Payroll Services, for pay-

Advance

ADI

ADO

Membership

MEM

ment.

Airfare

ARI

ARO

Mileage > IRS Rate

MIT*

MOT*

Baggage Handling

BGI

BGO

Mileage < or = IRS Rate

MLI

MLO

USE OF FORM: Use the form for the following purposes:

Car Rental

CRI

CRO

Network Services

NWK

1. To reimburse employees for authorized travel expenses.

CLA

Clothing Allowance

Other Expenses

OEI

OEO

2. To request and pay all travel advances.

CLN

Clothing-Non Contract

Parking

PKI

PKO

3. To request reimbursement for small cash purchases paid for by employees.

Communications - Other

COM

Photocopies

CPI

CPO

COMPLETION OF THE FORM: Employee: Complete, in ink, all parts of this

Postal, Mail & Shipping

Conference/Registration Fee

CFI

CFO

PMS

form. If claiming reimbursement, enter actual amounts you paid, not to exceed

Svcs.(outbound)

the limits set in your bargaining agreement or compensation plan. If you do not

Department Head Expense

DHE

Storage of State Property

STO

know these limits, contact your agency's business expense contact. Employees

SMP

Fax

FXI

FXO

Supplies/Materials/Parts

must submit an expense report within 60 days of incurring any expense(s) or the

FDS

Freight & Delivery (inbound)

Telephone, Business Use

BPI

BPO

reimbursement comes taxable.

Hosting

HST

Telephone, Personal Use

PHI

PHO

TRG

Laundry

LDI

LDO

Training/Tuition Fee

All of the data you provide on this form is public information, except for your home

Lodging

LGI

LGO

Taxi/Airport Shuttle

TXI

TXO

address. You are not legally required to provide your home address, but the state of

Meals With Lodging

MWI

MWO

Vest Reimbursement

VST

Minnesota cannot process certain mileage payments without it.

Meals Without Lodging

MEI*

MEO*

Note: * = taxable, taxed at supplemental rates

Supervisor: Approve the correctness and necessity of this request in compliance with existing bargaining agreements or compensation plans and all other applicable rules and poli-

cies. Forward to the agency business expense contact person, who will then process the payments. Note: The expense report form must include original signatures.

Final Expense For This Trip?: Check this box if there will be no further expenses submitted for this trip. By doing this, any outstanding advance balance associated with this trip will

be deducted from the next paycheck that is issued.

1-Way Commute Miles: Enter the number of miles from your home to your permanent workstation.

Expense Group ID: Entered by accounting or payroll office at the time of entering expenses. The Expense Group ID is a unique number that is system-assigned. It will be used to

reference any advance payment or expense reimbursement associated with this trip.

Earn Code: Select an Earn Code from the list that describes the expenses for which you are requesting reimbursement. Be sure to select the code that correctly reflects whether the

trip is in state or out-of-state. Note: Some expense reimbursements may be taxable.

Travel Advances, Short-Term and Recurring: An employee can only have one outstanding advance at a time. An advance must be settled before another advance can be issued.

Travel Advance Settlement: When the total expenses submitted are less than the advance amount or if the trip is cancelled, the employee will owe money to the state. Except for

rare situations, personal checks will not be accepted for settlement of advances; a deduction will be taken from the employee's paycheck.

FMS ChartStrings: Funding source(s) for advance or expense(s)

Mileage: Use the Mileage Reimbursement Calculation table to figure your mileage reimbursement. Mileage may be authorized for reimbursement to the employee at one of two

rates (referred to as the higher or lower rate). The rates are specified in the applicable bargaining agreement/compensation plan. Note: If the mileage rate you are using is above the

IRS rate at the time of travel (this is not common), part of the mileage reimbursement will be taxed.

Vehicle Control #: If your agency assigns vehicle control numbers follow your agency’s internal policy and procedure. Contact your agency’s business expense contact for more

information on the vehicle control number procedure.

Personal Travel Benefits: State employees and other officials cannot accept personal benefits resulting from travel on state business as their own. These benefits include frequent

flyer miles/points and other benefits (i.e. discounts issued by lodging facilities.) Employees must certify that they have not accepted personal travel benefits when they apply for tra-

vel reimbursement.

Receipts: Attach original itemized receipts for all expenses except meals, taxi services, baggage handling, and parking meters, to this reimbursement claim. The Agency Designee

may, at its option, require attachment of meal receipts as well. Credit card receipts, bank drafts, or cancelled checks are not allowable receipts.

Copies and Distribution: Submit the original document for payment and retain a copy for your employee records.

FI-00529-07 (08/11)