Instructions on completing the
RECURRING TRIP REIMBURSEMENT
request form

---

For complete University Policy and Regulations pertaining to Travel, see: www.ucop.edu/ucophome/policies/bfb/g28.html

This form should be used to request reimbursement for travelers who do regular, non-flight travel over a period of time (e.g., field supervisors performing school site visits). Because the BSO’s "Travel Reimbursement Request Form" only allows for one trip per form, this form will be useful for travelers involved in recurring non-flight travel trips. Please note that only private vehicle mileage, bus fare, BART fare, train/rail fare, toll, and parking costs can be requested for reimbursement using this form; any airfare, meal, or lodging reimbursement associated with travel must be requested using the Travel Reimbursement Request Form. If you have any questions about which form is most appropriate, please contact your budget assistant (for a list of BSO Budget Assistants, click here); it is always best to contact the BSO prior to your travel.

Except when private car mileage is requested, all costs to be reimbursed must be accompanied by receipts, which should be taped (not stapled) to 8½" x 11" sheets of white paper (the back of scratch paper is fine). If a receipt has been lost or is not available, please attach a statement of explanation.

Request Date: Enter today’s date.

Name: Enter traveler’s name.

Address: Enter traveler’s residence address. Travelers who are not UCB employees or students: this is also the address where your reimbursement will be sent, unless otherwise instructed.

Phone: Provide traveler’s phone number; this contact information is necessary should the Business Office need to contact the traveler.

E-mail: Enter traveler’s e-mail address.

Empl ID/Student ID/SS#/Fed Tax ID: Enter as appropriate traveler’s Employee ID, Student ID, Social Security, or Federal Tax ID (if a UCB employee is being reimbursed, provide his/her Employee ID; if a UCB student is being reimbursed, provide his/her Student ID, etc.).

Dates of Travel: Provide the month and year for which travel expenses are being reported.

Trip Purpose: Provide a brief business explanation for the trip.

Vehicle License Plate Number: If traveler is requesting private car mileage, provide the vehicle license plate number of the vehicle used for travel.

Is your vehicle covered by the minimum prescribed liability insurance?: Check the appropriate box. Note that the vehicle must be covered by at least the minimum prescribed liability insurance coverage as follows:

(1) $50,000 for personal injury to, or death of, one person;

(2) $100,000 for injury to, or death of, two or more people in one accident; and

(3) $50,000 for property damage.

In the table, provide the information requested, using one line per trip:
Date: Provide the date of travel.
RT: Check the box if travel was round trip (leave blank if one-way travel).
Fr: School/Project Site, City, Campus: Give starting location (e.g., UC Berkeley, Berkeley).
To: School/Project Site, City, Campus: Give destination location (e.g., El Cerrito High School, El Cerrito).
Code: Indicate type of cost, using the code provided. If you are filling out this form on the computer, a drop-down menu will appear at each line; select appropriate cost type. If you are filling out this form by hand, enter appropriate code. Use only the code choices provided; if you are seeking reimbursement for a cost type not coded, you should not use this form—use the Travel Reimbursement Request form.

PV = Private Vehicle

BS = Bus

BT = BART

TR = Train/Rail

TL = Toll

PK = Parking

# of Miles: If travel was by private vehicle, provide the number of miles driven and leave the "Amount" column blank; reimbursable amount will be automatically calculated in the Total Mileage field.
Amount: Provide amount of travel cost. If travel was by private vehicle, leave this column blank and provide number of miles drive under "# of Miles" column.

Certification By Traveler: Traveler must sign here.

Acct Name/Fund Source: Provide the account name or funding source (e.g., Ford grant) to be charged.

Approval Signature: Have the principal investigator (PI) of the funding source sign in this field, authorizing the BSO to charge travel costs against this account. If the PI has designated another individual to sign approval on expenses for a particular account, that individual should sign in this field (note that the BSO must be informed by the PI in writing that another individual can sign for Travel expenses).

Last updated: 4/1/08

Back to Business Office Forms