Claim For Travel Expense With Instructions Form. This is a Nevada form and can be use in Administrative Office Of The Courts Statewide.
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SUPREME COURT CLAIM FOR TRAVEL EXPENSE Guidelines for completing the Supreme Court Claim for Travel Expense form (travel claim) Please Note: The Supreme Court's Claim for Travel Expense form has been revised. The revised form and corresponding instructions are posted on the Supreme Court's internet at http://www.nvsupremecourt.us/documents/index.php?typeID=1 using the keyword, "travel claim." Travel claims should be submitted within 30 days from the time the traveler left travel status. Original receipts are required to be reimbursed for all expenses except for meals at the standard rates, incidentals, and lodging $70.00 per night or less. Name: Enter the traveler’s name Title: Enter the traveler’s title Mailing Address: Enter the traveler’s mailing address Judicial/Business Affiliation: Enter the name of the agency or business the traveler works for. Examples would be the Supreme Court, 2nd Judicial District Court, Clark County Clerk’s Office, Carson City Municipal Court, etc. Official Station: Enter the name of the city and state where the traveler’s office of employment is located. Employee Identification Number (EID): Applies to state employees only. State employees should enter their five digit EID number in the space provided. Purpose of the Trip: Briefly describe the purpose of the trip, i.e., the reason the travel was necessary. An example would be, “Attended a Specialty Court Funding Committee meeting.” Please be specific and do not use acronyms. Traveler is a …: Check the box that most closely describes the traveler. Airline Ticket Purchase: Check the box provided if the traveler used the Administrative Office of the Court’s (AOC) SWABIZ account or used an AOC preferred travel agent 1 to reserve and charge an airline ticket directly to the AOC in relation to the purpose of the travel. If the box is checked, the traveler should not include the cost of the airline ticket on the travel claim when itemizing his or her expenses for the trip. The traveler should however attach a copy of the passenger coupon to the travel claim. Date: Enter the dates the traveler entered and left travel status in this column. Destination: Enter the city the traveler departed from, traveled to, and returned to in this column. Include the state when the traveler traveled out-of-state or when the traveler traveled to Nevada from out-of-state. Time in Travel Status: Enter the time the traveler entered/started travel status (the time the traveler left home or the office) and the time the traveler left/ended travel status in the applicable column. Times must be entered in order to be reimbursed for meals. Transportation: Personal Vehicle: If the traveler utilized his or her personal vehicle, enter the number of miles driven while in travel status in the column provided. Effective 7/1/08 mileage is reimbursed at 58.50 cents per mile if the personal vehicle was used for the convenience of the state. Mileage is reimbursed at 29.25 cents per mile if the personal vehicle was used for the traveler’s convenience and another means of travel would have been cheaper. Other Transportation: If requesting reimbursement for other transportation expenses incurred while in travel status, enter, in the column provided, the transportation code found on the travel claim form that describes the type of transportation utilized by the 1Ambassador Travel, Las Vegas (702) 870-7000, Classic Travel, Carson City (775) 883-9331, The Travel Center, Reno (775) 323- 0110 American LegalNet, Inc. www.FormsWorkflow.com traveler. The cost incurred for use of other transportation should be entered in the column next to the transportation code column. An original receipt must be attached to the travel claim in order to be reimbursed if the RC (rental car), GR (ground transportation), or P (plane) codes are used. If the traveler used a rental car, the traveler will be reimbursed for the cost of a mid-size or smaller car. Insurance charges are not reimbursable. If the traveler used a state motor pool car, the motor pool form that the traveler received when returning the car must be attached to the travel claim. Daily Expenses: Meals: Travelers can be reimbursed for each meal on each applicable day of travel within the time frames below. Enter the rate the traveler is claiming for meals in the column provided. Meals will be reimbursed at the standard rates below without a receipt, or meals will be reimbursed an amount equal to the federal allowance rates found at www.gsa.gov under the per diem/meals and incidental breakdown links for the city/state of destination. An original itemized receipt and a printed copy of the GSA meals and incidental rates for the city/state of the destination from the GSA website must be attached to the travel claim in order to be reimbursed an amount higher than the standard rate. Standard Travel Times (if starting before & ending after) Per Diem Rates Meal 7:00 am – 9:00 am: $ 7.00 Breakfast (B) 11:00 am – 1:00 pm: $ 11.00 Lunch (L) 5:00 pm – 7:00 pm: $ 18.00 Dinner (D) Lodging: Enter the amount the traveler paid for overnight lodging if the purpose of the travel required the traveler to stay at a hotel overnight. The traveler can be reimbursed $70.00 for lodging per night without a receipt, or can be reimbursed an amount equal to the federal allowance rate for the traveler’s city/state of destination found at www.gsa.gov under the per diem link. An original receipt and a printed copy of the GSA lodging rate for the city/state of destination from the GSA website must be attached to the travel claim in order to be reimbursed an amount over $70.00. Incidental Expense: A $3.00 per day incidental expense can be claimed if the traveler incurred costs for fees relating to luggage carts, metered parking, toll charges and tips. Receipts are not required. Enter the amount in the applicable column for each day the expense was incurred. Parking: Enter the cost the traveler incurred for airport or other parking in the space provided on the travel claim form. An original receipt must be attached to the travel claim to be reimbursed for this cost. ATM Fees: This fee is only reimbursable to those who have a state issued Diner’s Club card for judicial travel purposes. Enter the amount the traveler was charged for using an automatic teller machine (ATM) during the course of travel. Bank receipts must be attached to the travel claim form in order to be reimbursed for ATM fees. The traveler can be reimbursed up to a maximum of $7.00 for this cost. Signatures: An original signature of the traveler at the bottom of the travel claim form, using blue ink, is required in order to be reimbursed. A supervisory signature is required for travelers working under the direction of a supervisor. Questions concerning completion of the travel claim form or questions regarding the costs that are eligible for reimbursement, should be directed to Jan McGinty at (775) 684-1718, or Anna Verbanac at (775) 684-1716, of the Administrative Office of the Court’s accounting unit. American LegalNet, Inc. www.FormsWorkflow.com CLAIM FOR TRAVEL EXPENSE SUPREME COURT OF NEVADA 201 S. Carson St., Suite 250, Carson City, NV 89701-4702 Name: Title: Mailing Address: Telephone Number: Facsimile Number: Judicial/Business Affiliation: Official Station (city, state): Employee ID # (state employees only): Traveler is a (check one): Purpose of the Trip: Supreme Court Justice or Supreme Court/AOC Employee Senior Justice or Senior Judge District Court Judge or Employee Municipal or Justice Court Judge or Employee State Executive Branch Agency Employee Judicial Board or Commission Member Independent Contractor Other Check here if the Supreme Court/Administrative Office of the Courts paid for an airline ticket in relation to this travel claim. Include costs for airline tickets below only if the traveler paid for an airline ticket and is requesting reimbursement. Destination Date (Cities/locations traveled to and from) Time in Travel Status (Indicate a.m. or p.m.) Began Ended Transportation Codes: AV (agency vehicle) MP (State Motor Pool car) RC (rental car) P (plane) X GR (ground transportation such as taxis, shuttles, subway, city bus, etc.) (passenger in car) Transportation Personal Vehicle # of Miles Driven .5850 or .2925 per mile Cost Daily Expenses Other Trans Enter Code from Above Cost $7.00 Breakfast $11.00 Lunch $18.00 Dinner $3.00 Total for Meals Lodging Inci-dental Total for the Day Parking (airport or other) Diners Club ATM Fee Total Claimed Original travel claims and signatures are required to be reimbursed. No fax transmittals are accepted. Maximum amounts to be reimbursed for meals and lodging can be found at www.gsa.gov under the per diem link. Original itemized receipts are required and must be attached to the travel claim in order to be reimbursed for: 1. Airline tickets; 2. Parking; 3. Transportation expenses (rental car, shuttle, taxi, etc.); 4. Lodging over $70 per night; 5. Meals in excess of the standard rates above; 6. Diners Club ATM fees; and/or 7. Registration or similar expenses associated with the reason for travel. The travel claim must be submitted for reimbursement within 30 days of travel status. Prior approval of travel by the Supreme Court, AOC, and/or the Judicial Education manager, is required in order to be reimbursed for travel to conferences or out-of-state. I declare under penalty of perjury that this claim and accompanying evidence has been examined by me and to the best of my knowledge and belief is a true and correct claim in conformance with Supreme Court and other governing authority statutes and policies. Signature of Traveler Date Signature of Approving Authority Please use blue ink when signing or approving this form. This form was approved for use and distribution by the Nevada Supreme Court July 2008. 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