This form is used by UA Little Rock employees, students, and guests of state for the purpose of claiming reimbursement of travel expenses incurred by the traveler for meals, lodging, mileage on personal cars, and itemized miscellaneous expenses. A recapitulation of all expenses incurred and claimed by the UA Little Rock employee must appear on this form. Receipts must be provided for all detailed expense items with the exception of meals. All copies must have original signatures.
Please contact Lanita Shepherd at 501-569-8622 or email@example.com if you have any questions or need help completing this form.
PLEASE PRINT OR TYPE THIS FORM
Traveler – Name of Payee: Enter the name of the traveler.
Travel Authorization Number: Enter the number from the traveler copy of the Travel Authorization (TA) form.
Official Station: Enter the agency assigned official station for the traveler. (Campus Location)
Department: Enter the UA Little Rock Department of the traveler.
CTS Card Number: Enter the last four digits of the department’s CTS card number (enter even if there were no charges). Put N/A only if the department does not have a CTS card.
Place of Residence and Address: Enter the address of the traveler. (Enter even if reimbursement is by direct deposit.)
Check Distribution: Check if you want your reimbursement mailed to your home address or if you wish to pick up your check.
Email Address: Email address of payee.
From and To: Enter the point that travel began (From) and concluded (To) for each day traveled. Additional vicinity miles MUST be listed on a separate line to be reimbursed.
Vicinity Mileage: Enter vicinity mileage as “VICINITY.” Do not go into detail. Vicinity miles MUST be listed on a separate line to be reimbursed.
Mileage Driven: Enter the mileage between the points listed using the Rand McNally Mileage Calculator. Vicinity mileage should be listed on a separate line to be reimbursed.
Reimb. Claimed: Enter the product of Miles Driven and the rate per mile indicated on the form.
Date: Enter the dates of travel.
Name of Town Visited: Enter the town(s) where expenses were incurred.
Detailed Expenditures (Other Than Mileage): Enter the amount of actual out-of-pocket costs to be reimbursed for each item shown. Indicate by number all amounts shown in the “incidentals” column. (See *Incidentals on TR-1 form). Hotel expenses should be broken down into the daily room charge and taxes. Receipts must be attached for all items claimed except meals. Receipts are required for reimbursement for meals purchased for Guests of State.
Direct Billed: List total of daily expenditures listed for each line that were paid by the University by check.
CTS Purchase: List total of the daily expenditures on this line that were paid by a CTS card (travel card).
Reimb. Claim: This should calculate automatically. If not, then enter the total of the expenditures on that line that should be reimbursed to the traveler.
Grand Total: Enter the total being claimed for reimbursement.
Less Travel Advance: Indicate the total travel advance received by the traveler before the trip.
Due Traveler: This should calculate automatically. It is the difference between what is due the traveler and the travel advance.
Travel Supervisor: For Financial Service use only.
Signature of Traveler: The traveler must sign all copies.
Title of Traveler: Enter the title of the traveler.
Signature of Department Head: Department Head must sign all copies. This must be a supervisor of the traveler. Traveler and Department Head cannot be the same signature. It is the responsibility of the Department Head to attest the validity of all data on the TR-1.
Title of Department Head: Enter the title of the department head.