Employee Reimbursement Information and Instructions

• Policies
• Procedures
• Instructions for the Employee Voucher (Employee Reimbursement) Form CO-17XP
• Instructions for the Employee Voucher (Employee Reimbursement) Form CO-17XP For Moving Expense Reimbursement

The following are some examples of out-of-pocket minor expenses:

• Host taking a guest to lunch.
• Xeroxing at an off-campus facility.
• Minor emergency purchase in connection with a research project or to facilitate a department's operation.
• Reference materials (books, tapes, etc.) purchased at a seminar or conference.
• Tuition and training cost (professional development) as provided in the Collective Bargaining Agreements.
• Travel expense reimbursements.
• Candidate / Employee moving expense reimbursements.

To request the non-payroll payment, an Employee Voucher (Employee Reimbursement) Form CO-17XP must be prepared by the employee or department involved.

All expenses must be supported by original receipts or vendor invoices and attached to Form CO-17XP.

All non-payroll payments, except the travel expense reimbursements, must be approved the Department Head, or other approved authorized official.

Note: Blank Employee Vouchers can also be obtained from the Health Center's Central Warehouse.

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The completed form, with all original receipt(s) or vendor invoice attached, should be submitted to the Department Head, or an authorized designee for approval.

If an on-line Employee Voucher Form is used, send only the original approved form with the original receipt(s) stapled to the form.

If a hardcopy is used, send only the Goldenrod and Green copies of the form, with original receipt(s) or vendor invoice to the Accounts Payable Office (MC 4031). Please staple all receipts and invoices to the Employee Voucher Form.

The employee/ department should retain the pink copy of the Employee Voucher Form and a copy of all receipts and invoices for future reference.

The reimbursement check will be mailed directly to the employee's home address.

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The Employee Voucher Form CO-17XP is used by Health Center employees/ departments to claim reimbursement for actual expenses incurred.

Please type the following information on the form:.

(1) AGENCY NO.
The agency number is "UHC 72000".

(2) BATCH NO.
Leave Blank. The Batch Number will be assigned by Accounts Payable and General Accounting.

(3) DOC. TYPE
The document type is "XP" for an individual employee.

(4) DOCUMENT NO.
Document number is located on the previous page, enter that number here. If you are using the excel form,  go to the Employee Voucher Form page to get a Document Number. Enter that number here or use a unique department number.

(5) DOCUMENT AMOUNT
The total reimbursement amount.

(6) DOCUMENT DATE
The date this Employee Voucher Form CO-17XP is prepared.

(7) RECEIPT DATE
The date the merchandise was received. If over a period of time, use the ending date. If traveling, use the first day of the trip.

(8) TA NO. (IF APPLICABLE)
Enter TA number

(9) PERIOD COVERED (FROM/TO)
Enter the first day of the trip (mmddyyyy) and the last day of the trip.  If reimbursement is for a product or service, leave blank.

(10) VENDOR FEIN/ SSN - SUFFIX
Enter employee's Social Security Number.

(11)  PAYEE NAME AND ADDRESS
Enter full name of the employee and home address.

(12) COLLECTIVE BARGAINING IDENTIFICATION - UNIT AND CLASS NUMBER
If employee is faculty, management, professional, or special payroll, type "Board of Trustees Exclusion," otherwise enter the Bargaining Unit under which the employee is covered.

(13) PAYEE'S TITLE
The employee's job title,

(14)  PAYEE'S SIGNATURE
This must be the original signature of the employee.
 
Note: Employee's signature also certifies the traveler has automobile insurance at a minimum value of $50,000/$100,000.

(15) DATE
Enter the date the Employee Voucher is signed by the employee.

(16) ADVANCE FROM PETTY CASH - AMOUNT (IF APPLICABLE)
Enter the amount of cash advance received from the Bursar's Office.

(17) PAYEE'S SIGNATURE
If a petty cash advance was received and the amount is entered on line (16), employee's original signature is required.

(18) REMARKS, EXPLANATION OF UNUSUAL ITEMS, ETC.
Briefly explain the nature, occasion, and purpose of the expenditure, as well as the date, place, and name of person(s) involved (or who incurred the expense).

(19) AUTHORIZED SIGNATURE
The authorized signature of the Department Head, PI, or authorized designee.

(20) FY
Enter current fiscal year (yy)

(21) EXPENDED AMOUNT
Each portion of the expense to be reimbursed must correspond to the proper account coding on that line.

(22) Leave Blank

(23-25) LEDGER, ACCOUNT, SUBCODE
Enter ledger, account and subcode that was approved on the TA (Travel Authorization Form)
(L-AAAAA-SSSS).

(26)-28) PERSON TO CONTACT, PHONE, MAIL CODE
Enter name of the preparer, phone extension and mail code (MC-xxxx).

(29) DATE MO/DA
Enter the month and day(s) of travel. Enter each day separately per line.

(30) TRAVEL (FROM/TO)
Enter city or airport traveling from and to.  Enter each leg of the trip.

(31) TIME (DEPART/ARRIVE)
Enter the time of departure and arrival for each leg of the trip.

(32) TRAVEL BY AUTOMOBILE
Note:  The traveler must maintain automobile insurance at a minimum value of $50,000/$100,000.

- Misc. Exp Pkg, Tolls, Gas, Oil, Etc.    Enter the type of  miscellaneous expenses related to travel by auto.
- Amount                                                    Enter the amount of miscellaneous expenses.
- No. of Miles                                             Enter number of miles traveled by personal car.
- GSA Rate                                                 Toggle for the current GSA Rate - $ amt will be calculated.

(33) OTHER TRAVEL (CODE, AMOUNT)
Enter Code: B=Bus, R=Rail, C=Cab,O=Other.
Enter Amount.

(34) LODGING
Enter the cost of lodging for each day (per line).

(35) MEALS (CODE, AMOUNT)
Enter Code: B=Breakfast, L=Lunch, D=Dinner
Enter total amount of meals for each day (per line).

(36) MISC (CODE, AMOUNT)
Enter Code: P=Telephone, T=Tips, W=Wire, O=Explain
Enter total amount for each day (per line).

(37) UCHC DEPARTMENT
Enter the department name the traveler is associated with.

(38) DEPARTMENT MAIL CODE
Enter the mail code associated with department.

(40) DATE APPROVED
Leave Blank.  General Accounting will enter date when the reimbursement is approved.

(41) AMOUNT APPROVED
Leave Blank.  General Accounting will enter the amount approved

(42) SIGNATURE - GENERAL ACCOUNTING APPROVAL
Leave Blank.  General Accounting with sign off on form.

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