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					                                             CALIFORNIA STATE UNIVERSITY , LONG BEACH

                                            TRAVEL EXPENSE CLAIM                                                                                                                          Vendor ID #
                                    Revised 4/06/11

                                      All trav el claims must be submitted w ithin 30 days of the trav el return date
                                                                                                                                                                                                                                                 Yes           No
                                                                                                                                                                                      (1) Completed Def ensiv e Driv ing Class?
   (2) Claimant's Status
   CHOOSE ONE:                           Employee               Student             Non Employee*
                                                                                      *Non employees must have a Vendor 204 form attached or on file with Accounts Payable.
Attach All Receipts and Supporting Documentation to Your Travel Expense Claim
                       (3) CLAIMANT'S NAME, POSITION TITLE                                                                                                       (4) CAMPUS ID              (5) DEPARTMENT                           (6) DIVISION



                                  (7) CLAIMANT'S STREET ADDRESS                                                                     (8) CITY/STATE/ZIP CODE                                  (9) CAMPUS EXT                              (10) REF #




                                                                                                                           (16)
                                                                          (14)                                                            (17) CARFARE                  (18)                           (19)
     (11)              (12)               (13)                                                                          AIRFARE /                                                                                                         (20)
                                                            MEALS (Taxable for same day travel)                                              TOLLS &              PRIVATE CAR USE          MISC. EXPENSE, including.
 DATE & TIME       DESTINATION         LODGING                                                             (15)        RENTAL CAR /                                                                                                  TOTAL EXPENSE
                                                                                                                                             PARKING                 $0.50   RATE                  Registration
                                                         Breakfast      Lunch            Dinner      *INCIDENTALS          RAIL                                                                                                         FOR DAY
                                                                                                       (Taxable for
                                                                                                    same day travel)                                       (a)      Miles    (b) Amount



                                                                                                                                                                                $0.00                                                                   $0.00

                                                                                                                                                                                $0.00                                                                   $0.00

                                                                                                                                                                                $0.00                                                                   $0.00

                                                                                                                                                                                $0.00                                                                   $0.00

                                                                                                                                                                                $0.00                                                                   $0.00

                                                                                                                                                                                $0.00                                                                   $0.00

                                                                                                                                                                                $0.00                                                                   $0.00

                                                                                                                                                                                $0.00                                                                   $0.00

     Totals                                $0.00          $0.00         $0.00              $0.00          $0.00               $0.00             $0.00                  0      $0.00                   (21) Total Trip Cost                             $0.00
                                                                                                                                                                                                      (22) Less Amount Exceeding
                                                                                                                                                                                                      Maximum Cost Allowed

(31) Chartfields                                                                                                                                                                                      (23) Total Trip Cost Approv ed *                 $0.00

   Amount            Account            Fund ID          Dept ID       Program            Class         Project           (33)   3rd Party Billing #                 Addtl Info (Dept use)            (24) Less Prepaid Airfare


                                                                                                                                                                                                      (25) Less Prepaid Rental Car



                                                                                                                                                                                                      (26) Less Adv ance Payments



                                                                                                                                                                                                      (27) Less Foundation Payments *



                                                                                                                                                                                                      (28) Less Pro-Card Registration
                                                                                         (32)                                             (32a) Total
                   (31a) Total               If fund is split with Foundation, AP    Foundation                                             Paid by
      $0.00       Trip Cost *                             will forward your claim     Account #                                           Foundation       $                                          (29) Less Other Payments



                                                                                                                                                                                                      (30) Balance due Claimant                        $0.00



(34) PURPOSE OF TRIP, REMARKS, AND DETAILS




I certify that the above is a true statement of the travel expenses incurred by me while traveling on official University business. The original of all required documents are attached herein. I have received the appropriate authorization to travel and am
aware of the CSU travel guidelines related to this expense, I will not seek reimbursement for a duplicate claim or from another other source. I agree to return any reimbursement or payment issued by the University which subsequently results in a
refund, within 30 days of its receipt. If a motor vehicle was operated in the course of this claim, it was done so in full compliance of state laws and CSU policy.
(35) CLAIMANT'S NAME (PLEASE PRINT)                                                                                                          (35a) CLAIMAINT'S SIGNATURE                                                                            DATE



I certif y that the f unds are av ailable f or this expenditure and that this expenditure is reasonable and necessary f or the department's operations and the Univ ersity 's mission.
(36) APPROPRIATE ADMINISTRATOR/APPROVER NAME (PLEASE PRINT)                                                     (36a) APPROPRIATE ADMINISTRATOR/APPROVER SIGNATURE                                                                                 DATE




Dept Use (Optional)



                                                                                                           FOR ACCOUNTING USE ONLY
Reportable Meal (circle one):                         YES                     NO
Voucher #                                                             Inv oice                                                              Inv oice                                                                         Total

   Acct #                                                              Acct #                                                               Acct #
                                                                                                                                                                                                                       Tech's INTLs
  Amount                                                              Amount                                                               Amount




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                                                                      CALIFORNIA STATE UNIVERSITY, LONG BEACH
                                                                                Travel Expense Claim
                                                                                    Instructions

I.     Purpose

This form is intended to be used for the purpose of reimbursing individuals for money spent while
traveling on official University business. It is the Claimant’s responsibility to ensure that authorization
to travel has been obtained from the appropriate administrators within the organization in accordance with CSU, Long Beach’s travel authorization policy.


II.     Procedure for Completing the Travel Expense Claim
1. Completed Defensive Driving Class: Indicate whether you have taken the defensive driving course or not.
2. Claimant’s Status – Choose whether the Claimant is an employee, student, or non-employee.
      Please note that non-employees must have a Vendor 204 form on file with Accounts Payable or attached to the Travel Expense claim.
3. Claimant’s Name - Enter the name of the person that traveled on behalf of the University.
4. Campus ID – Enter the University issued Campus ID number of the Claimant.
5. Department – Enter the name and number of the department the Claimant is employed by.
6. Division – Enter the name of the division the Claimant is employed by.
7. Claimant’s Street Address – Enter the Claimant’s home mailing address.
8. City/State/Zip Code – Enter the Claimant’s city, state, and zip code.
9. Campus Ext – Enter the campus extension used to contact the Claimant.
10. Ref # - Enter the department’s internal reference number.
11. Date & Time – Enter the date(s) and time(s) of travel.
12. Destination – Enter the city and state abbreviation of the Claimant’s destination.
13. Lodging – Enter the actual cost of the lodging. An original itemized hotel receipt is required.
14. Meals – Enter the total daily amount for meals (breakfast, lunch, and/or dinner).
15. Incidentals – Incidentals of $7 per day are allowed with an overnight stay.
16. Airfare, Rental Car, and/or Rail - Enter airfare, rental car, and/or rail charges; attach all documentation supporting these charges.
17. Carfare, Tolls, and Parking – Enter carfare, taxi, shuttles, bridge tolls, parking charges and attach receipts as required
18. Private Car Use
      a. Miles – Enter the number of business miles to and from the trip destination.
    b. Amount – (This field will populate automatically). Multiple the number of miles driven by the current rate of reimbursement.
19. Misc. Expense – Enter any miscellaneous expenses associated with this trip and provide receipts when available. (includes registration)
20. Total Expense for Day – (This field will populate automatically). This represents the total costs of the day’s expenditures.
                                                                   CALIFORNIA STATE UNIVERSITY, LONG BEACH
                                                                             Travel Expense Claim
                                                                                 Instructions

21. Total Trip Cost – (This field will populate automatically). This represents the expenses for the entire trip.
22. Less Amount Exceeding Maximum Cost – Enter the amount of any expenses over the amount approved that are being paid personally by the Claimant. – Negative Number.
23. Total Trip Cost Approved – (This field will populate automatically). This represents amount of funding authorized by the approving authority.
Lines 24 thru 29 should be entered as Negative Numbers
24. Less Prepaid Airfare – Enter the amount of any prepaid airfare, Giselle’s/Global, or a previous reimbursement.
25. Less Prepaid Rental Car – Enter the amount of any prepaid rental car fees.
26. Less Advance Payments – Enter the amount of any cash advance payments made for this trip.
27. Less Foundation Payments – Enter the amount of costs being paid by the CSULB Foundation.
28. Less Pro-Card Registration – Enter the amount of registration costs prepaid with a procurement card or other campus paid method.
29. Less Other Payments – Enter the amount of any other costs not listed above that have been prepaid for this trip.
30. Balance Due Claimant – (This field will populate automatically) this represents the total amount due to the Claimant after subtracting any prepaid expenses and Foundation payments.
31. Chartfields (Amount, Account, Fund Source, Fund ID, Dept ID, Program, Class, Project) – Enter the appropriate chartfields to which the expenses should be charged.
    Use multiple lines if funding is being split.
    a. Total Trip Cost – (This field will populate automatically) this represents the Total Trip Cost approved and should match line #23 less lines #27 & #28 on the Travel Expense Claim.
32. Foundation Account – If the CSULB Foundation is required to pay a portion of the travel claim, enter the Foundation Account number being charged.
   a. Total Paid by Foundation – Enter the total amount being paid by the Foundation.
33. Billable to 3rd party – Check the appropriate box if any amounts are being charged to an auxiliary or other 3rd party, the billing number must be included.
   (ex. Grant billing number 07- xxxxx)
34. Purpose of the Trip, Remarks, and Details – Describe purpose of travel. Enter detail or explanation of items in other columns, if necessary.
35. Claimant’s Name – Print the name of the Claimant.
   a. Claimant’s Signature/Date – The Claimant’s signature and date claim is signed.
36. Appropriate Administrator Name/Date – Print the name of the approving officer.
   a. Appropriate Administrator Signature – The approving authority’s signature and date of approval.

				
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