Expense Reimbursement and Honorarium

Expenses in connection with duly authorized travel for ASN will be reimbursed upon the presentation of properly prepared vouchers signed by the claimant and approved by the appropriate ASN staff in charge of the activity concerned. Please include receipts for ALL expenses, whether seeking reimbursement or making a contribution to ASNF. Without receipts, we will be unable to issue a reimbursement or letter recognizing your donation for tax purposes.

This form must be returned within 30 days after the conclusion of the meeting or event in order to receive reimbursement. Reimbursement will not be provided if received after the deadline.

Step 1 of 2

Claimant's Personal Information

Your Name(Required)

First Last

Your Email Address(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Phone(Required)

Purpose of Travel(Required)

Be specific; include persons and/or organizations visited, reason for visit or meeting attended and event date

Date of Departure

Date of Return

Expenses

Please furnish all information requested - incomplete forms may not be reimbursed (Carolyn, confirm wording here)

Air Travel Expense

Economy-class fares must be used except when approved by the Executive Officer. First-class fares will be permitted if the less than first-class accommodations are clearly unreasonable or impractical (i.e. not available for reasons other than an avoidable delay in making reservations, would require circuitous routing or entail additional expenses offsetting savings on fare, or would not make necessary connections).

Mileage Expense

Reimbursement for the use of traveler’s automobile on authorized travel will be at the standard mileage rate as determined by the IRS. This shall cover all operating costs including gasoline, oil, etc. [Actual amounts paid for tolls and parking may be claimed]. However, reimbursement for the use of the traveler’s automobile cannot exceed the cost of the same travel by air. Please visit www.irs.gov for current standard mileage rates.

Taxi, Rental Car, Other Transit Expense

Transit expenses (taxis, subway fares, tolls, parking) will be reimbursed to the traveler at actual cost. The use of a rental car in lieu of public transportation must be justified. ASN may set a cap on reimbursable transit expenses.

Hotel Expense

Cost of hotel rooms will be reimbursed on an actual cost basis if a receipt from each hotel is attached. The reimbursement shall be at the rate of a single room (if available); otherwise, a written explanation should accompany this voucher. The cost of a room shared with persons not on ASN business should be pro-rated on an equitable basis.

Meals, Incidental Expenses

Actual expenses for meals, tips, baggage handling, etc., will be reimbursed to the traveler up to a maximum allowance of $59.00 for each calendar day in travel status. For partial travel days, incidental expenses up to one-half of the per diem rate (ASN employees only)will be allowed for each half or fraction thereof a calendar day. Dates and times of departure and return must be entered on this form in order to receive the full per diem allowance. ASN Employees claiming full per diem allowance must deduct the cost of meals provided by ASN and other parties. The per diem allowance for trips by automobile cannot exceed the applicable per diem allowance had the travel been made by air.

Do you have other allowable expenses?(Required)

Personal expenses such as laundry, valet, travel insurance, telephone calls, internet, etc., are not allowable charges

Yes

Other Expense

Enter itemized description here:

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Honorarium

(If Applicable)

Total(Required)

Select one:

Please consider the full amount a tax-deductible contribution to the ASN Foundation (ASNF).

Please consider $100 a tax-deductible contribution to ASNF and reimburse me for the remainder.

Please consider a different tax-deductible contribution to ANSF, listed by me below, and reimburse me for the remainder.

Hidden

Full Donation

Hidden

$100 Donation

My Tax-Deductibe Donation

Balance Due

Upload Your Receipts(Required)

Upload your receipts in .pdf, .doc, .docx, .jpg, or .png format

Drop files here or

Accepted file types: pdf, doc, docx, jpg, png, jpeg, Max. file size: 25 MB.

Expense Reimbursement Form

Step 1 of 2

Claimant's Personal Information

Your Name(Required)

First Last

Your Email Address(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Phone(Required)

Purpose of Travel(Required)

Be specific; include persons and/or organizations visited, reason for visit or meeting attended and event date

Date of Departure

Date of Return

Expenses

Please furnish all information requested - incomplete forms may not be reimbursed (Carolyn, confirm wording here)

Air Travel Expense

Mileage Expense

Taxi, Rental Car, Other Transit Expense

Hotel Expense

Meals, Incidental Expenses

Do you have other allowable expenses?(Required)

Personal expenses such as laundry, valet, travel insurance, telephone calls, internet, etc., are not allowable charges

Yes

Other Expense

Enter itemized description here:

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Honorarium

(If Applicable)

Total(Required)

Select one:

Please consider the full amount a tax-deductible contribution to the ASN Foundation (ASNF).

Please consider $100 a tax-deductible contribution to ASNF and reimburse me for the remainder.

Please consider a different tax-deductible contribution to ANSF, listed by me below, and reimburse me for the remainder.

Hidden

Full Donation

Hidden

$100 Donation

My Tax-Deductibe Donation

Balance Due

Upload Your Receipts(Required)

Upload your receipts in .pdf, .doc, .docx, .jpg, or .png format

Drop files here or

Accepted file types: pdf, doc, docx, jpg, png, jpeg, Max. file size: 25 MB.