Form GAO-502 "Employee Expense Reimbursement Form" - Arizona

What Is Form GAO-502?

This is a legal form that was released by the Arizona Department of Administration - General Accounting Office - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2017;
  • The latest edition provided by the Arizona Department of Administration - General Accounting Office;
  • 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 fillable version of Form GAO-502 by clicking the link below or browse more documents and templates provided by the Arizona Department of Administration - General Accounting Office.

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Download Form GAO-502 "Employee Expense Reimbursement Form" - Arizona

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State of Arizona
Purpose/Instructions: To record expenses incurred by employees on behalf of the State for purposes
and to effect proper
OTHER THAN TRAVEL
reimbursement of those expenses through HRIS and accounting of those expenses in AFIS. This form is not to be used for recording recurring,
Employee Expense Reimbursement Form
periodic employee allowances of a fixed amount. This form is not to be used to request or approve advances or allowances of any kind.
Claimant and Claimant’s Supervisor/Manager
Date
Amount
Description
Agency Name
Incurred
Claimant’s (Employee’s)
EIN
Name
Date
Claimant’s (Employee’s)
Signature
By signing above, the claimant/employee certifies that the amounts for which reimbursement is claimed and the receipts to support
such claim represent amounts actually spent for valid public purposes in the conduct of official business for the State.
EIN
Supervisor’s/Manager’s
Name
Supervisor’s/Manager’s
Date
Signature
Total
By signing above, the claimant’s/employee’s supervisor/manager certifies that the expenses claimed were incurred for
authorized State business that they are correct and proper charges and that the reimbursement thereof, hereby approved, is
Receipts (originals or true copies) must
consistent with all applicable statutes, laws, appropriations, grants and contracts.
be attached for all amounts claimed.
For Agency Approval and Payroll Entry
Pay
PPE Incurred
Pay
Accounting
Acct’g
Description
Code
Amount
Date*
Dist Fund
Unit
Object
BFY
Activity
Category
Uniform Reimbursement †
7311
600
W’less Device Reimburse’t †
7179
650
Repairs & Maintenance-Vehicle
7256
652
Tools Reimbursement †
7269
654
Office Supplies
7321
656
Housekeeping Supplies
7341
658
Educ’n Assistance Program ‡
7452
659
Educ’n Assist Other Non-Tax ‡
7452
660
Educ’n Assist Other Taxable ‡
7452
661
Conference Registration Fees
7455
662
Postage and Delivery
7481
664
Emp’ee Recognition Expend’s
7511
668
Dues & Professional Licenses
7531
670
Employee Relocation Expenses
7593
672
Misc/TRVL–Persons in Custody
6295
690
Other Misc Op’ting Expenses ‡
7599
698
Total
By my signature below and to the right, I certify that the expenses for which reimbursement is claimed were for
*See Detailed
Reimbursem ents , not Allowanc es
official state business and payment thereof will not exceed appropriation, allotment or other authorized funds.
Instructions
Refer to S tate P olicies
Entered by
(Payroll Entry Personnel)
Signature/Initials
EIN
Date
Agenc y Authorized Signature
EIN
Date
Form GAO-502 (08/2017)
Print Form
State of Arizona
Purpose/Instructions: To record expenses incurred by employees on behalf of the State for purposes
and to effect proper
OTHER THAN TRAVEL
reimbursement of those expenses through HRIS and accounting of those expenses in AFIS. This form is not to be used for recording recurring,
Employee Expense Reimbursement Form
periodic employee allowances of a fixed amount. This form is not to be used to request or approve advances or allowances of any kind.
Claimant and Claimant’s Supervisor/Manager
Date
Amount
Description
Agency Name
Incurred
Claimant’s (Employee’s)
EIN
Name
Date
Claimant’s (Employee’s)
Signature
By signing above, the claimant/employee certifies that the amounts for which reimbursement is claimed and the receipts to support
such claim represent amounts actually spent for valid public purposes in the conduct of official business for the State.
EIN
Supervisor’s/Manager’s
Name
Supervisor’s/Manager’s
Date
Signature
Total
By signing above, the claimant’s/employee’s supervisor/manager certifies that the expenses claimed were incurred for
authorized State business that they are correct and proper charges and that the reimbursement thereof, hereby approved, is
Receipts (originals or true copies) must
consistent with all applicable statutes, laws, appropriations, grants and contracts.
be attached for all amounts claimed.
For Agency Approval and Payroll Entry
Pay
PPE Incurred
Pay
Accounting
Acct’g
Description
Code
Amount
Date*
Dist Fund
Unit
Object
BFY
Activity
Category
Uniform Reimbursement †
7311
600
W’less Device Reimburse’t †
7179
650
Repairs & Maintenance-Vehicle
7256
652
Tools Reimbursement †
7269
654
Office Supplies
7321
656
Housekeeping Supplies
7341
658
Educ’n Assistance Program ‡
7452
659
Educ’n Assist Other Non-Tax ‡
7452
660
Educ’n Assist Other Taxable ‡
7452
661
Conference Registration Fees
7455
662
Postage and Delivery
7481
664
Emp’ee Recognition Expend’s
7511
668
Dues & Professional Licenses
7531
670
Employee Relocation Expenses
7593
672
Misc/TRVL–Persons in Custody
6295
690
Other Misc Op’ting Expenses ‡
7599
698
Total
By my signature below and to the right, I certify that the expenses for which reimbursement is claimed were for
*See Detailed
Reimbursem ents , not Allowanc es
official state business and payment thereof will not exceed appropriation, allotment or other authorized funds.
Instructions
Refer to S tate P olicies
Entered by
(Payroll Entry Personnel)
Signature/Initials
EIN
Date
Agenc y Authorized Signature
EIN
Date
Form GAO-502 (08/2017)
Print Form
Detailed Instructions for the Form GAO-502, State of Arizona Employee Expense Reimbursement Form
This page is for instructional purposes only and need not be printed or retained with the claim.
General Instructions
This form is not to be used to claim travel reimbursements or advances.
This form is not to be used to record allowances.
Certain expenditures, such as those relating to education, have complicated tax consequences. Consult GAO Central Payroll or, should it be available, published policy.
All receipts and other documentation supporting the claimed amounts should be attached to this form and retained for a period prescribed by the Arizona State Library, Archives and
Public Records Division of the Arizona Secretary of State.
Claimant and Claimant’s Supervisor/Manager
Of the boxes in the Claimant and Claimant’s Supervisor/Manager section at the top of the form, the Total must be completed and the amount in this box must equal the sum of the
amounts entered in the Amount column. The amount in the Total box in the upper section must equal the amount in the Total box in the lower section. Sometimes there will be only
one entry in the Amount column and sometimes several, but there must always be at least one entry in the Amount column.
For any line in which there is an entry in the Amount column, all of the columns of that entry—Date Incurred and Description—must be completed. The Date Incurred is the date
upon which the expenditure for which the employee is seeking reimbursement was made.
All of the following boxes must be completed: Agency Name; Claimant’s (Employee’s) Name, EIN, Signature and Date (of signing); Supervisor’s/Manager’s Name, EIN,
Signature and Date (of signing).
For Agency Approval and Payroll Entry
Of the boxes in the lower section, For Agency Approval and Payroll Entry, the Total must be completed and the amount in this box must equal the Total amount in the Claimant
and Claimant’s Supervisor/Manager section above. (When using the automated version of this form, you will be warned and not allowed to print using the Print Form button, if
these two boxes are not equal). The sum of the amounts entered in the Amount column must equal the amount in the Total box. Sometimes there will be only one entry in the
Amount column and sometimes several, but there must always be at least one entry in the Amount column.
For any line in which there is an entry in the Amount column, all of the columns related to that entry—Pay Code, PPE Incurred Date, Pay Dist (Payroll Distribution), Fund
(Appropriated Fund), Accounting Unit, BFY (Budget Fiscal Year), Activity and Acct’g Category (Accounting Category)—must be completed. (In HRIS, many of these columns are
automatically filled by the system; they may, however, be manually overridden. The relationship of the Pay Code to the expense/expenditure Description and to the Object is fixed.)
The PPE Incurred Date is the ending date of the payroll period in which the expenditure for which the employee seeks reimbursement was made or, in the case of educational
expenses requiring the completion of a course or the accomplishment of certain grades, could first be claimed.
In the case of Pay Dist (Payroll Distribution), enter the value that identifies how the labor cost will be allocated. Enter ‘Y’ to override the labor distribution displayed and to use a
multiple setup on the XR23.3 screen in HRIS; enter ‘N’ to allow the labor distribution to default to the employee’s record.
Form GAO-502 (08/2017)
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