Relocation Expense Reimbursement Agreement

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					INSTRUCTIONS FOR COMPLETING THE MOVING AND RELOCATION EXPENSE WORKBOOK

Fields: Yellow – Manual entry

       Peach – Auto-populates from the worksheets

       Red Category alpha text headings (A – G) – Cursor over for Policy requirements

       *Red arrows – Cursor over for additional information or limitations

1.     Complete the applicable worksheets.

          Entering more than one receipt in a field:

               Use the = sign to enter each separate receipt that contributes to the field total
               amount. (i.e., meal receipts for the final move total $41.03. Enter the separate receipts as
               =11.01+9.50+8.28+12.24)

2.     Staple the receipts together, and identify by Category alpha letter A – G. (i.e., for the example
       above, the label is G.)

3.     Print the Reimbursement Certification sheet (Certification of Moving Expenses).
       Obtain signatures and document the date of each signature.
       Attach all original receipts.
       Attach a signed copy of the Moving Agreement.

4.     Mail the Certification of Moving Expenses sheet and original receipts to:

       Moving and Relocation
       University Human Resources
       PO Box 400127


5.     Send the Summary Expense Workbook electronically (e-mail attachment) to:

       moveandrelocate@virginia.edu



For assistance, please phone 434-982-2943 or send an e-mail to moveandrelocate@virginia.edu
                                          UNIVERSITY OF VIRGINIA
                                 MOVING AND RELOCATION EXPENSE SUMMARY

               Always refer to Policy: https://policy.itc.virginia.edu/policy/policydisplay?id=FIN-013
              PRINT THIS PAGE AND AFFIX ORIGINAL RECEIPTS. MAIL PER INSTRUCTIONS.


                                           Certification of Moving Expenses

                                              To Be Completed By Employee

Employee's Full Name:                                                                        Employee Number

Current Home Address:

This is the Final Reimbursement (select one):               YES            NO


Total Amount on this Request for Reimbursement:             $             -

I certify the expenses submitted here were incurred by me while moving and relocating at the request of the
University of Virginia.

Employee Signature:                                                                   Date

                                             To Be Completed By Department

Department Name:                                                                Department Number:

Head of Dept (printed):


Head of Dept Signature:                                                                       Date

Date Moving Agreement Signed:                                            Employee's Start Date:


 Prepared by (in Dept) print name:

 Preparer e-mail, phone and fax:

PTAO for Reimbursement Expense:

FOR HUMAN RESOURCES USE ONLY

The expenses itemized above were incurred in an employee relocation move requested by the Commonwealth of Virginia
and do not exceed the requirements set forth in the Department of Accounts Moving and Relocation Expense regulations.
Written approval for reimbursements above normal established limits is attached.

Signature of Approving Officer: .                                                                     .

Date:                                  .                                                             .

Print Name:                        .                                                                  .

Title:                            .                                                                   .
                                        UNIVERSITY OF VIRGINIA
                               MOVING AND RELOCATION EXPENSE SUMMARY

               Always refer to Policy: https://policy.itc.virginia.edu/policy/policydisplay?id=FIN-013
                                Paid receipts must be submitted for all requests.

Employee's Full Name:                                            Department Name:

                           Summary of Moving Agreement Reimbursements
     Total Amount Reimbursable Direct to the Employee

     Total Prior Reimbursement(s) Direct to Employee



                                      TAXABLE REIMBURSEMENTS
                                                                                 Current
                                                                                 Request             Notes

 A   House Hunting Summary                                                   $        -
 B   Temporary Housing Summary                                               $        -
 C   Cancellation of Lease (Only if due to relocation)                       $        -
 D   Selling Residence Summary                                               $        -
 E   Buying Residence Summary                                                $        -
 F   Final Move (Meals and Mileage) Summary                                  $        -

                        Total Taxable Reimbursement Request                  $        -


                                  NON-TAXABLE REIMBURSEMENTS
                                                                                 Current
                                                                                 Request             Notes

 G   Travel From Prior to New Residence Summary                              $        -
 H   Self-Move Summary                                                       $        -

                Total Non-Taxable Reimbursement Request                      $        -

     Total submitted on this Reimbursement Request                           $        -



     Remaining Reimbursement Amount per Moving Agreement                     $        -



                                   Total Agreement Maximum Amount

     Total Maximum Moving Agreement Amount

     UVA Total Paid or PO amount for Common Carrier

     Requisition or Purchase Order Number
                                          UNIVERSITY OF VIRGINIA
                                 MOVING AND RELOCATION EXPENSE SUMMARY

                 Always refer to Policy: https://policy.itc.virginia.edu/policy/policydisplay?id=FIN-013
                                  Paid receipts must be submitted for all requests.

Employee's Full Name:                                                   Department Name:

                                        TAXABLE REIMBURSEMENTS
                                                               Total    Mileage       Current
  A House Hunting                                             Mileage    Rate         Request         Notes

Trip #1                                          Lodging
                                                   Meals
                                                     Tolls
                            2010 Personal vehicle mileage               $0.500    $        -
                            2011 Personal vehicle mileage               $0.510    $        -
            OR             Car Rental/Other transportation
                                     Fuel Reimbursement

Trip #2                                          Lodging
                                                   Meals
                                                     Tolls
                            2010 Personal vehicle mileage               $0.500    $        -
                            2011 Personal vehicle mileage               $0.510    $        -
            OR             Car Rental/Other transportation
                                     Fuel Reimbursement

Trip #3                                          Lodging
                                                   Meals
                                                     Tolls
                            2010 Personal vehicle mileage               $0.500    $        -
                            2011 Personal vehicle mileage               $0.510    $        -
            OR             Car Rental/Other transportation
                                     Fuel Reimbursement

  A                   House Hunting Reimbursement Total                           $        -

                                                                                      Current
  B       Temporary Housing                                                           Request         Notes

                           Lodging or Rent (up to 90 days)
                 Parking fees (if required at temp housing)
                                      Meals (up to 30 days)

  B              Temporary Housing Reimbursement Total                            $        -

  C       Cancellation of Lease
                                  UNIVERSITY OF VIRGINIA
                         MOVING AND RELOCATION EXPENSE SUMMARY

          Always refer to Policy: https://policy.itc.virginia.edu/policy/policydisplay?id=FIN-013
                            Signed HUD statement must be submitted

Employee's Full Name:                                        Department Name:

                                 TAXABLE REIMBURSEMENTS
                                                                  Current
  D Selling Prior Primary Residence                               Request             Notes

                              Real Estate Commission
                                        Attorney's fees
                                         Escrow Fees
                         State or Local Transfer Taxes
                                        Pest Inspection

  D             Selling Residence Reimbursement Total         $        -

                                                                  Current
  E    Buying New Primary Residence                               Request             Notes

                                         VA funding fee
              Loan origination fee/lease processing fee
                                       Mortgage survey
                                           Appraisal fee
                                          Credit Report
                                            Title Search
                                          Recording fee
                                         Title insurance
                                          Attorney's fee
                              Home inspection (limit 1)
                                             Notary fees

  E             Buying Residence Reimbursement Total          $        -
                                         UNIVERSITY OF VIRGINIA
                                MOVING AND RELOCATION EXPENSE SUMMARY

               Always refer to Policy: https://policy.itc.virginia.edu/policy/policydisplay?id=FIN-013
                                Paid receipts must submitted for all requests.

Employee's Full Name:                                                   Department Name:


                                        TAXABLE REIMBURSEMENTS
                                                               Total                  Current
  G Final Move (Meals & Mileage)                              Mileage                 Request       Notes
                                     Final Move Meals
        Jan 1 - Dec 31, 2010 Personal vehicle mileage                    $0.335   $        -
        Jan 1 - Jun 30 2011 Personal vehicle mileage                     $0.320   $        -
                 Jul 1 2011 - Personal vehicle mileage                   $0.320   $        -
  G             Final Move Taxable Reimbursement Total                            $        -

                                    NON-TAXABLE REIMBURSEMENTS
                                                                        Mileage       Current
  F    Travel from prior to new residence                               Rate          Request       Notes

                                                  Lodging
        Other Transportation if not driving (air fare, etc)
         Jan 1 - Dec 31 2010 Personal vehicle mileage                    $0.165   $        -
         Jan 1 - Jun 30 2011 Personal vehicle mileage                    $0.190   $        -
                  Jul 1 2011 - Personal vehicle mileage                  $0.235   $        -
              OR Personal Vehicle Fuel and/or Tolls

  F       Travel to New Residence Reimbursement Total                             $        -

                                                                                      Current
  G Self-Move (not using Moving Company)                                              Request       Notes

                      Truck Rental/PODs/Shipping, etc.
                               Fuel - Self Move Vehicle
                                       Packing Supplies
                               Labor to help with move
                            Storage Unit (30 days max)
                       Other travel expenses (explain)

  G         Self-Move Non-Taxable Reimbursement Total                             $        -

				
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