Get DoJ NIC Travel & Per Diem Claim Form 2013-2024

NATIONAL INSTITUTE OF CORRECTIONS TRAVEL AND PER DIEM CLAIM FORM Send to Harris Group Services P. O. Signature Please check one Rev 9-18-13 This claim is complete NIC TRAVEL AND PER DIEM CLAIM FORM Continuation Page SECTION II Cont DESCRIPTION OF EXPENSES 20 DATE Explanations if any SAMPLE CLAIM FORM SECTION 1 - Lodging Costs - Base Taxes 1/5/00 Portland Oregon 174. Box 2244 Alpharetta GA 30023-2244 NIC ACTIVITY NO. Name Last First Middle Initial SSN Mailing Address include zip code Telephone No* Location of Event / Project City County State INSTRUCTIONS Please provide the following information in chronological order The date of departure place of departure and mode of authorized travel to airport/train station etc* all authorized ground transportation while on-site lodging mode of travel used to return to home/office and indicate cost of each expense. Times should be those in effect at localities involved* NOTE Original receipts are required for lodging expenses and all other single expenses exceeding 75. 00 except for the following Meals - No receipts are required* Reimbursement will be calculated for you using established Federal daily localityrates that cannot be exceeded and beginning and ending times of authorized travel and Personally Owned Vehicles POV No receipts are required however beginning and ending odometer readings or paper or electronic standard highway mileage guides must be provided for reimbursement of this expense to be considered* POV costs based on established Federal travel mileage rates will be calculated for you. Lodging and Lodging Taxes Please claim as separate items in Section I below Please see Sample of a completed Claim Form on the reverse side. Dates SECTION 1 - LODGING COSTS - BASE TAXES Lodging City Base Lodging TOTAL LODGING COSTS Lodging Taxes SECTION II - DESCRIPTION OF ALL OTHER TRAVEL EXPENSES DEPARTURE/ARRIVAL CITY MODE OF TRAVEL AND OTHER EXPLANATIONS OF EXPENSES TRAVEL EXPENSES Additional Space is Available on the Back. Please feel free to copy this form if necessary I certify that the information provided in this Claim Form is true and correct to the best of my knowledge and belief and that payment or credit has not been received by me. 00 40. 00 DESCRIPTION OF ALL OTHER TRAVEL EXPENSES DP Boldview via POV ODOM 35 101 - 35 167 For National Airport DP Airport via AA 4222 and AA/822 DP Airport via shuttle round trip AR Hotel All transportation while on site provided by DOC 21. 45 684. 00 22. 00 DP Hotel via shuttle AR Airport DP National Airport via POV 35 167 - 35 233 AR Residence Airport parking Total Lodging Costs 25. Box 2244 Alpharetta GA 30023-2244 NIC ACTIVITY NO. Name Last First Middle Initial SSN Mailing Address include zip code Telephone No* Location of Event / Project City County State INSTRUCTIONS Please provide the following information in chronological order The date of departure place of departure and mode of authorized travel to airport/train station etc* all authorized ground transportation while on-site lodging mode of travel used to return to home/office and indicate cost of each expense. Times should be those in effect at localities involved* NOTE Original receipts are required for lodging expenses and all other single expenses exceeding 75. .