VRR Employee Expense Reimbursement Request Employee InformationEmployee Name(Required) First Last Employee Email(Required) Employee Phone Number(Required)Employee Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code At this time reimbursements will be done through paper checks mailed to employees home address.Purpose of Travel / Expense and Primary Team Expense is Assigned Too.Primary Team Expense Falls Under(Required)Admin Team - John KilpatrickAccounting Team - Carrie RussellClinical Team - April BerryCommunity Integration Team - Jeremy FletcherTestYour reimbursement request will be routed to the appropriate team lead for review first. All Con Ed expenses will be routed to Admin Team not Clinical or other teams.Program Expense Belongs To If this belongs to a particular program please state here. Example :Mental Health First AidPurpose of Travel / Expense(Required)Was expense or travel pre approved?(Required)YesNoDates - Mileage - Per Diem Rates - Hotel CostDate Travel Started Month Day Year For calculating Per Diem.Date Travel Ended (Returned) Month Day Year For calculating Per Diem.Destination Zip CodeFor calculating Per Diem.Per Diem RatesPer Diem Daily RatePer Diem rate for destination - use GSA link in team portalFirst and Last Daily RateTravel on first and last day is paid at lower rateNumber of FULL DaysOnly FULL days at destination day of travel to and from destination is paid at First and Last Daily Rate.Per Diem Total(First + Last Day Rate) + (Daily Full Rate * Number of Full Days)MileageActual Mileage DrivenIf personal vehicle was driven. Actual Mileage from Veterans Recovery Resources - 1156 Spring Hill Ave to destination and return.Mileage RateMileage is reimbursed at the above rate.Mileage TotalMultiply mileage (ROUND TRIP) by $0.585GSA Travel TotalAdd Per Diem + Mileage + LodgingPer Diem Total(Number of Full Days * Per Diem Daily Rate) + First Day Rate + Last Day Rate (If ONLY traveling for one day only First Day Travel Rate is paid)Mileage Reimbursement TotalMultiply actual mileage by $0.585 to come up with Mileage Reimbursement Total.Lodging TotalTotal lodging cost paid for travel.Additional ExpensesExpense Description - Expense Total Add RemoveList additional expenses and total. (use + on side to add additional expenses)Reimbursment Request TotalTotal Reimbursement RequestAdd - Per Diem Total + Mileage Total + Lodging + Any Additional ExpensesI understand that this reimbursement request is an an estimation using the GSA website for travel allowed amounts and additional expenses and is subject to approval.(Required) I Understand Upload Receipts Drop files here or Select files Max. file size: 50 MB. Upload Receipts from hotel stay as well as any other relevant claimed expenses. RedirectRedirect(Required) I Understand When you click submit you will be redirected to the Expense Tracker. Please input the information on that tracker so that you may track and know where your reimbursement request is at in the process. IF PROMPTED TO SIGN IN USE THE FOLLOWING: email: vrrexpensetracker@gmail.com pw: P@$$word1
