Form CO-112 "Travel Authorization Request" - Connecticut

What Is Form CO-112?

This is a legal form that was released by the Connecticut Office of the State Comptroller - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 20, 2010;
  • The latest edition provided by the Connecticut Office of the State Comptroller;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CO-112 by clicking the link below or browse more documents and templates provided by the Connecticut Office of the State Comptroller.

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Download Form CO-112 "Travel Authorization Request" - Connecticut

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STATE OF CONNECTICUT
TRAVEL AUTHORIZATION REQUEST
OFFICE OF THE STATE COMPTROLLER
CO-112 REV.7/2010
1. Use this form for travel requiring prior approval.
3.
If requesting reimbursement from Union Travel Funds,
forward a complete set to the Office of the State
(1) DATE OF REQUEST
2. For identification of requests, please assign a separate
Comptroller, Fiscal Policy Division, Travel Unit, 55 Elm
number to each Request form, and enter it under block 2
Street, Hartford, CT 06106-1775. When Department
T.A. Number
funded, retain copy for audit purposes.
(2) T.A. NUMBER
(3) BUSINESS UNIT NAME & ADDRESS TO WHICH FORM SHOULD BE RETURNED (Include Zip Code)
BUSINESS UNIT NO.
TELEPHONE NUMBER (Business Office)
(4) EMPLOYEE NAME (FOR WHOM AUTHORIZATION IS REQUESTED)
(5) EMPLOYEE NUMBER
(6) TITLE
(7) SPECIFY BARGAINING UNIT NUMBER , MANAGEMENT OR OTHER
COLLECTIVE
BARGAINING
NP-1
NP-2
NP-3
NP-4
NP-5
NP-8
P-1
P-2
P-3A
P-4
P-5
P-3B
OTHER (Specify)
NP-6
MANAGEMENT
IDENTIFICATION
(8) WORK TELEPHONE NO. (Include extension no.)
(9) HOME TELEPHONE NO.
(10) OFFICIAL DUTY STATION (Give complete address)
(13) MISCELLANEOUS INFORMATION (Actual
(11)
(12)
ITINERARY
DATES
time of departure from home and return to
home).
HOME
FROM
TO
TO
YES
NO
Parking Permit Requested?
(14) OBJECT AND NECESSITY OF TRAVEL (Attach substantiating documents)
(15) TYPE OF TRANSPORTATION
(Specify)
PROOF OF AUTO INSURANCE
RAIL
RENTAL CAR
PERSONAL CAR
STATE OWNED CAR
OTHER
ON FILE AT AGENCY?
AIR
YES
NO
(16)
TOTAL COST (Itemize) NOTE; RATES FOR MEALS AND LODGING SHOULD NOT EXCEED THOSE PROVIDED FOR IN STANDARD TRAVEL REGULATIONS AND IN COLLECTIVE BARGAINING AGREEMENTS.
AIRFARE
PERSONAL MILEAGE
(
)
MI@
LODGING
RATE
REFERENCE
WITH RIDER:
CONFERENCE HOTEL
RIDER(S) TA #
OTHER
TAXI(S)
MEALS
(17)
REGISTRATION FEE
TAX
TOTAL COST
RAIL
GRATUITIES
(18)
(19)
(22)
(24)
(25)
(23)
(20)
(21)
(27)
(26)
PROJECT/
BUDGET
CHARTFIELD
CHARTFIELD
AMOUNT
FUND
DEPARTMENT
ACCOUNT
SID
PROGRAM
GRANT
REFERENCE
2
1
(28) SIGNATURE OF EMPLOYEE
DATE
OFFICE OF THE STATE COMPTROLLER
(Authorized Signature/Date)
(29) APPROVED BY (Supervisor, Div. Head, Director, Dean etc.)
DATE
(30) AUTHORIZED BY (Business Unit Head or Authorized Agent))
DATE
DISTRIBUTION ORIGINAL - (FOR UNION FUNDS ONLY), COMPTROLLER'S, FISCAL POLICY DIVISION, TRAVEL UNIT
COPIES TO - BUSINESS UNIT & EMPLOYEE
ORIGINAL - (NON- UNION FUNDS) - AGENCY BUSINESS OFFICE
COPY
- EMPLOYEE
STATE OF CONNECTICUT
TRAVEL AUTHORIZATION REQUEST
OFFICE OF THE STATE COMPTROLLER
CO-112 REV.7/2010
1. Use this form for travel requiring prior approval.
3.
If requesting reimbursement from Union Travel Funds,
forward a complete set to the Office of the State
(1) DATE OF REQUEST
2. For identification of requests, please assign a separate
Comptroller, Fiscal Policy Division, Travel Unit, 55 Elm
number to each Request form, and enter it under block 2
Street, Hartford, CT 06106-1775. When Department
T.A. Number
funded, retain copy for audit purposes.
(2) T.A. NUMBER
(3) BUSINESS UNIT NAME & ADDRESS TO WHICH FORM SHOULD BE RETURNED (Include Zip Code)
BUSINESS UNIT NO.
TELEPHONE NUMBER (Business Office)
(4) EMPLOYEE NAME (FOR WHOM AUTHORIZATION IS REQUESTED)
(5) EMPLOYEE NUMBER
(6) TITLE
(7) SPECIFY BARGAINING UNIT NUMBER , MANAGEMENT OR OTHER
COLLECTIVE
BARGAINING
NP-1
NP-2
NP-3
NP-4
NP-5
NP-8
P-1
P-2
P-3A
P-4
P-5
P-3B
OTHER (Specify)
NP-6
MANAGEMENT
IDENTIFICATION
(8) WORK TELEPHONE NO. (Include extension no.)
(9) HOME TELEPHONE NO.
(10) OFFICIAL DUTY STATION (Give complete address)
(13) MISCELLANEOUS INFORMATION (Actual
(11)
(12)
ITINERARY
DATES
time of departure from home and return to
home).
HOME
FROM
TO
TO
YES
NO
Parking Permit Requested?
(14) OBJECT AND NECESSITY OF TRAVEL (Attach substantiating documents)
(15) TYPE OF TRANSPORTATION
(Specify)
PROOF OF AUTO INSURANCE
RAIL
RENTAL CAR
PERSONAL CAR
STATE OWNED CAR
OTHER
ON FILE AT AGENCY?
AIR
YES
NO
(16)
TOTAL COST (Itemize) NOTE; RATES FOR MEALS AND LODGING SHOULD NOT EXCEED THOSE PROVIDED FOR IN STANDARD TRAVEL REGULATIONS AND IN COLLECTIVE BARGAINING AGREEMENTS.
AIRFARE
PERSONAL MILEAGE
(
)
MI@
LODGING
RATE
REFERENCE
WITH RIDER:
CONFERENCE HOTEL
RIDER(S) TA #
OTHER
TAXI(S)
MEALS
(17)
REGISTRATION FEE
TAX
TOTAL COST
RAIL
GRATUITIES
(18)
(19)
(22)
(24)
(25)
(23)
(20)
(21)
(27)
(26)
PROJECT/
BUDGET
CHARTFIELD
CHARTFIELD
AMOUNT
FUND
DEPARTMENT
ACCOUNT
SID
PROGRAM
GRANT
REFERENCE
2
1
(28) SIGNATURE OF EMPLOYEE
DATE
OFFICE OF THE STATE COMPTROLLER
(Authorized Signature/Date)
(29) APPROVED BY (Supervisor, Div. Head, Director, Dean etc.)
DATE
(30) AUTHORIZED BY (Business Unit Head or Authorized Agent))
DATE
DISTRIBUTION ORIGINAL - (FOR UNION FUNDS ONLY), COMPTROLLER'S, FISCAL POLICY DIVISION, TRAVEL UNIT
COPIES TO - BUSINESS UNIT & EMPLOYEE
ORIGINAL - (NON- UNION FUNDS) - AGENCY BUSINESS OFFICE
COPY
- EMPLOYEE