Instructions for DJJ Form DFS-AA-15 "Voucher for Reimbursement of Travel Expenses" - Florida

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FDJJ 1407.01
Appendix B
Updated 3/5/07
APPENDIX B
VOUCHER FOR REIMBURSEMENT OF TRAVEL EXPENSES
FORM DFS-AA-15
Instructions for the completion of the Travel Reimbursement Request, (Form DFS-AA-15) are given below.
Numbers shown correspond to the attached facsimile form.
Blank #
Instructions
(1)
Traveler - The first name, middle initial, and the last name of the traveler. If the traveler is an
employee and is a Junior or a Third, etc., this designation must agree with the employee’s W -4 card
on file with the State Comptroller’s Office. Examples: (1) The W-4 card reads John Albert Jones, Jr.
The payee line of the travel voucher should read John A. Jones, Jr. (2) The W -4 card reads Bill
Steven Thompson, III. The payee line should read Bill S. Thompson, III.
(2)
People First ID Number - The traveler’s six digit PeopleFirst ID number.
(3)
Work Address – The street address to which the traveler is assigned.
(4)
HQ City - The Headquarters city to which the traveler is assigned.
(5)
CIR# - The Circuit to which the traveler is assigned.
(6)
City, State, Zip Code – The city, state, zip code to which the traveler is assigned.
(7)
Residence (City) - The city in which the traveler resides and where his/her personal mail is usually
addressed. This may be different than item (4).
(8)
Check One – Check the space, which identifies the traveler’s employment status.
(9)
Date - Place the month, day and two (2) digit year on which the travel was performed. List as
M/D/YY. Travel performed on January 2 would be shown as 1/15/07.
(10)
Travel Performed from Point of Origin to Destination - This column is used to indicate the city of
origin and the city of destination. (Example – “Tallahassee to Tampa”) If vicinity travel is claimed,
indicate city name and “vicinity”.
(11)
Purpose or Reason (Name of Conference) - This column is used to indicate the specific purpose of
the travel performed. If appropriate, indicate the name of the conference. Purpose or Reason may be
dittoed provided the statement is clear. Rather than “client related” be more explicit such as “home
visit for clients”. Abbreviations may be used if the abbreviation is self-explanatory.
(12)
Hour of Departure and Hour of Return - This column is used to indicate the exact time of departure
and time of return. It must be specified whether the hour is P.M. or A.M. The time of departure and
return must be shown on all T ravel Reimbursement Requests.
(13)
Meals for Class A and B Travel - List the amount of meals on a daily basis which qualify as Class A
or B meals.
(14)
Actual Lodging Expenses - This column is used to indicate the actual daily lodging expenses
claimed for the travel performed.
(15)
Per Diem Amount - This column is used to indicate the amount of per diem claimed for the travel
performed.
(16)
Map Mileage Claimed - When a privately o wned vehicle is used, indicate the point-to-point mileage
claimed, as it appears on the Official Mileage Chart. If a state vehicle is used, show tag number
here. If rental car is used, indicate name of rental agency.
(17)
Vicinity Mileage Claimed - This column is used to indicate the vicinity mileage claimed. Unusual
vicinity mileage will be subject to review.
(18)
Incidental Expenses Amount - This column is used to indicate the amount of incidental expenses.
Appendix B to DJJ 1407.01
FDJJ 1407.01
Appendix B
Updated 3/5/07
APPENDIX B
VOUCHER FOR REIMBURSEMENT OF TRAVEL EXPENSES
FORM DFS-AA-15
Instructions for the completion of the Travel Reimbursement Request, (Form DFS-AA-15) are given below.
Numbers shown correspond to the attached facsimile form.
Blank #
Instructions
(1)
Traveler - The first name, middle initial, and the last name of the traveler. If the traveler is an
employee and is a Junior or a Third, etc., this designation must agree with the employee’s W -4 card
on file with the State Comptroller’s Office. Examples: (1) The W-4 card reads John Albert Jones, Jr.
The payee line of the travel voucher should read John A. Jones, Jr. (2) The W -4 card reads Bill
Steven Thompson, III. The payee line should read Bill S. Thompson, III.
(2)
People First ID Number - The traveler’s six digit PeopleFirst ID number.
(3)
Work Address – The street address to which the traveler is assigned.
(4)
HQ City - The Headquarters city to which the traveler is assigned.
(5)
CIR# - The Circuit to which the traveler is assigned.
(6)
City, State, Zip Code – The city, state, zip code to which the traveler is assigned.
(7)
Residence (City) - The city in which the traveler resides and where his/her personal mail is usually
addressed. This may be different than item (4).
(8)
Check One – Check the space, which identifies the traveler’s employment status.
(9)
Date - Place the month, day and two (2) digit year on which the travel was performed. List as
M/D/YY. Travel performed on January 2 would be shown as 1/15/07.
(10)
Travel Performed from Point of Origin to Destination - This column is used to indicate the city of
origin and the city of destination. (Example – “Tallahassee to Tampa”) If vicinity travel is claimed,
indicate city name and “vicinity”.
(11)
Purpose or Reason (Name of Conference) - This column is used to indicate the specific purpose of
the travel performed. If appropriate, indicate the name of the conference. Purpose or Reason may be
dittoed provided the statement is clear. Rather than “client related” be more explicit such as “home
visit for clients”. Abbreviations may be used if the abbreviation is self-explanatory.
(12)
Hour of Departure and Hour of Return - This column is used to indicate the exact time of departure
and time of return. It must be specified whether the hour is P.M. or A.M. The time of departure and
return must be shown on all T ravel Reimbursement Requests.
(13)
Meals for Class A and B Travel - List the amount of meals on a daily basis which qualify as Class A
or B meals.
(14)
Actual Lodging Expenses - This column is used to indicate the actual daily lodging expenses
claimed for the travel performed.
(15)
Per Diem Amount - This column is used to indicate the amount of per diem claimed for the travel
performed.
(16)
Map Mileage Claimed - When a privately o wned vehicle is used, indicate the point-to-point mileage
claimed, as it appears on the Official Mileage Chart. If a state vehicle is used, show tag number
here. If rental car is used, indicate name of rental agency.
(17)
Vicinity Mileage Claimed - This column is used to indicate the vicinity mileage claimed. Unusual
vicinity mileage will be subject to review.
(18)
Incidental Expenses Amount - This column is used to indicate the amount of incidental expenses.
Appendix B to DJJ 1407.01
FDJJ 1407.01
Appendix B
Updated 3/5/07
(19)
Incidental Expenses Type - This column is used to indicate the type of incidental expenses.
Examples: rental car, reasonable taxi fare, ferry, bridge, road tolls; storage or parking fees;
registration fees; telephone; maps; etc.
(20)
Air Fare – This column is used when the traveler pays common carrier charges directly to the
vendor, the amount of air fare paid should be entered here and the carrier’s name entered on page 2
in the space designated “Travel Performed By Common Carrier or State Vehicle" Type,” i.e.,
USAir, Delta, Avis, etc.
(21)
List the total amount of all Class A and B meals claimed on this page (automatically calculated).
(22)
List the total amount of all lodging expenses claimed on this page (automatically calculated).
(23)
List the total amount of all per diem claimed on this page (automatically calculated).
(24)
List the total map mileage claimed on this page (automatically calculated).
(25)
List the total vicinity mileage claimed on this page (automatically calculated).
(26)
List the total amount claimed for incidental expenses on this page (automatically calculated).
(27)
List the total air fares page on this page (automatically calculated).
(28)
List the total amount of all Class A and B meals claimed on page 3 (automatically calculated).
(29)
List the total amount of all lodging expenses claimed on page 3 (automatically calculated).
(30)
List the total amount of all per diem claimed on page 3 (automatically calculated).
(31)
List the total map mileage claimed on page 3 (automatically calculated).
(32)
List the total vicinity mileage claimed on page 3 (automatically calculated).
(33)
List the total amount claimed for incidental expenses on page 3 (automatically calculated).
(34)
List the total air fares page on page 3 (automatically calculated).
(35)
Total amount of all Class A and B meals claimed (automatically calculated).
(36)
Total amount of all lodging expenses (automatically calculated).
(37)
Total amount of all per diem claimed (automatically calculated).
(38)
Total map and vicinity mileage claimed (automatically calculated).
(39)
Total amount of all mileage claimed multiplied by $.445/mile (automatically calculated).
(40)
Total amount of all incidental expenses (automatically calculated).
(41)
Total amount of all air fares (automatically calculated).
(42)
Summary Total - Grand total claimed on the entire travel voucher (automatically calculated).
(43)
Less Non-Reimbursable items on Purchasing Card (total amount of costs charged to the DJJ
Purchasing Card, which will be paid directly to the credit card company, not the traveler
(automatically calculated).
(44)
Less Travel Advance Received - The amount of any travel advance, which must be deducted from
the claim (automatically calculated).
(45)
Net Amount Due Traveler - The total amount due the traveler (automatically calculated).
(46)
Net Amount Due State – The total amount due the State if travel expenses exceed permitted
amounts (automatically calculated).
(47)
Org. Code - The SAMAS organizational unit to which the travel cost on the voucher will be charged
as determined by the supervisor.
(48)
EO - The SAMAS expansion option code to be used as determined by the supervisor.
Appendix B to DJJ 1407.01
FDJJ 1407.01
Appendix B
Updated 3/5/07
(49)
Object Code 261000 Amount - Automatic total of rental cars and incidental expenses.
(50)
Object Code 261100 Amount – Automatic total of per diem expenses.
(51)
Object Code 261200 Amount - Automatic total of Class A and B meals.
(52)
Object Code 261300 Amount - Automatic total of mileage expenses.
(53)
Object Code 261400 Amount - Automatic total of lodging expenses.
(54)
Object Code 261500 Amount - Automatic total of air fare expenses.
(55)
Object Code 269000 Amount - Automatic total of travel advance.
(56)
Invoice # - To be completed by the Bureau of Finance and Accounting.
(57)
Tran Date - To be completed by the Bureau of Finance and Accounting.
(58)
This entire block is for fiscal office use only and can be used for travel advance information.
Traveler’s Signature - The traveler should sign his or her legal name as it appears on the W -4 Form.
Note: Persons who subscribe to any claim which they do not believe to be true and correct as to every
material matter, or who willfully aid or assist in the preparation or presentation of a claim which is fraudulent
or false as to any material matter, will be guilty of a misdemeanor and upon conviction thereof, will be
punished accordingly. Whoever will receive an allowance or reimbursement by means of a false claim will
be civilly liable in the amount of the overpayment for the reimbursement of the public fund from which the
claim was paid.
(59)
Date - The date the traveler signs the travel voucher.
(60)
Traveler’s Title - The traveler’s official position title.
Supervisor’s Signature - The signature of the traveler’s supervisor.
Note: Supervisors should understand that they are certifying or affirming that to the best of their knowledge
the travel claimed by the traveler was on official business of the State of Florida and was performed for the
purpose(s) stated.
(61)
Signature Date - The date the supervisor signs the travel voucher. The supervisor must approve the
voucher no later than five days after receipt in accordance with Section 215.422, Florida Statutes
unless there is a bona fide dispute.
(62)
Supervisor’s Title - The supervisor’s official position title. The word “supervisor” alone is not
acceptable.
(63)
Prepared By - List the name of the person preparing the travel voucher that should be contacted to
resolve any questions.
(64)
Phone Number – List the telephone number of the preparer as identified in item 63.
(65)
Suncom Number - List the Suncom phone number of the preparer as identified in item 63.
Note: The reverse side of the travel voucher must be completed if: (1) common carrier transportation (airline,
rental car, etc.) is directly billed to the agency; (2) a state vehicle is used; (3) the traveler attended a
conference or convention; (4) the traveler made charges against the State of Florida Purchasing Card; or (5)
the traveler made non-reimbursable charges against the State of Florida Purchasing Card.
Travel Performed by Common Carrier or State Vehicle:
(66)
Date - Enter the date travel began.
(67)
Self-explanatory.
(68-69) From/To - City of departure and city of destination.
(70)
Amount - Total cost of common carrier charges as reflected on the ticket.
(71)
Self-explanatory.
Appendix B to DJJ 1407.01
FDJJ 1407.01
Appendix B
Updated 3/5/07
State of Florida Purchasing Card Charges
(72)
Date - Enter the date of the purchase.
(73)
Merchant/Vendor - Enter the official name of the merchant or vendor as it will appear on the credit
card charge invoice.
(74)
Description of Item Acquired - Enter a clear description of the item(s) purchased.
(75)
Amount - Enter the exact amount of the charge.
(76)
Total Reimbursable Charges - Enter total amount of charges.
(77)
Date - Enter the date the non-reimbursable item(s) was purchased.
(78)
Merchant/Vendor - Enter the official name of the merchant or vendor as it will appear on the credit
card charge invoice from whom you purchased the non-reimbursable item(s).
(79)
Description of Item Acquired - Enter a clear description of the non-reimbursable item(s)
purchased.
(80)
Amount - Enter the exact amount of the non -reimbursable charge. This must agree with the amount
of line (XX).
(81)
Total Non-Reimbursable Charges - Enter total amount of charges.
Statement of Benefits to the State: (Conference or Convention)
(82)
To be completed for conference/convention travel only. Should be identical to the benefits statement
made on the “Authorization to Incur Travel Expense,” Form DFS -AA-13.
Page 3
(83)
Same information as required on first page (blanks 9 – 20).
Appendix B to DJJ 1407.01
(2)
TRAVELER
(1)
PEOPLE FIRST ID#
STATE OF FLORIDA
WORK ADDRESS
HQ CITY
CIR #
(5)
(3)
(4)
VOUCHER FOR REIMBURSEMENT
CITY, STATE, ZIP CODE
RESIDENCE (CITY)
(6)
(7)
OF TRAVEL EXPENSES
Department of Juvenile Justice
(8)
Check One:
Employee
OPS
Nonemployee/Ind. Contractor
Hour of
Class
Actual
Per
Class C
Map
Vicinity
Incidental Expenses
Travel Performed From
Purpose or Reason
Depart &
A and B
Lodging
Diem
Meals
Mileage
Mileage
Date
Point of Origin to Destination
(Name of Conference)
Return
Meals
Expenses
Claimed
Claimed
Amount
Type
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
Air Fare
Amount
(20)
SUBTOTAL PAGE 1
(21)
(22)
(23)
(24)
(25)
(26)
(27)
SUBTOTAL PAGE 3
(28)
(29)
(30)
(31)
(32)
(33)
(34)
Column
Column
Column
Column
Column
(38)
Miles
Column
(48)
ORG CODE
(47)
EO
Total
Total
Total
Total
Total
Total
@ $.445/Mile
INVOICE#
(56)
(35)
(36)
(37)
(39)
(40)
(41)
OBJECT
AMOUNT
OBJECT
AMOUNT
TRAN. DATE
(49)
261000
261400
(53)
SUMMARY Total
(42)
(57)
(54)
261100
(50)
261500
LESS CLASS C MEALS (EMPLOYEE/OPS ONLY)
269000
LESS NON-REIMBURSABLE ITEMS ON PURCHASING CARD
)
261200
(55)
(
(51)
(43)
LESS TRAVEL ADVANCE
(
)
261300
(52)
(44)
Advance:
Revolving Fund:
NET AMOUNT DUE - TRAVELER
(45)
(58)
Warrant No.
Check No.
(46)
NET AMOUNT DUE TO STATE
Warrant Date
Check Date
Statewide Doc. Date
Agency Voucher
Pursuant to Section 112.061(3)(a), Florida Statutes, I hereby certify or affirm that to the best of m y knowledge the above travel was on official
business of the State of Florida and was performed for the purpose(s) stated above.
Agency Voucher No.
$0.00
Supervisor's Signature
I hereby certify or affirm that the above expenses were actually incurred by me as necessary travel expenses in the performance of m y official duties;
attendance at a conference or convention was directly related to official duties of the agency; any meals or lodging included in a conference or convention
Signature Date
(61)
registration fee have been deducted from this travel claim; and that this claim is true and correct in every material matter and same conforms in every respect
with the requirements of Section 112.061, Florida Statutes.
Supervisor's Title
(62)
Traveler's Signature
Prepared By
(63)
Signature Date:
Title:
(60)
(59)
\
Phone\Suncom Number
(64)
(65)
FA001
Revised 03/05/07
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