Moving Expense Reimbursement Instructions for the Employee Voucher Form

Please type the following information on the Employee Voucher Form CO-17XP.

(1) AGENCY NO.
The agency number is "7302."

(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."

(4) DOCUMENT NO.
Document number is pre-printed.

(5) DOCUMENT AMOUNT
The total moving expense reimbursement amount requested.

(6) DOCUMENT DATE
The date this Employee Voucher is prepared.

(7) RECEIPT DATE
The date the move is completed.

(8) COM. NO.
The Commitment Number is "67302."

(9) COM. TYPE
The document type "RR" is printed.

(10) COM. AGCY.
Leave Blank.

(11) LIQ.
Leave Blank.

(12) RPT. TYPE
Type “E.” All moving expense reimbursements are reported as “Miscellaneous Income” on IRS Form 1099.

(13) VENDOR FEIN/ SSN - SUFFIX
The employee's Social Security Number.

(14) PERIOD OF TRAVEL
Type "MOVING” and the departure and arrival dates.

(15)
Not listed.

Payee Certification

(16) PAYEE NAME AND ADDRESS
Type the Candidate/Employee’s full name and new home address.

(17) COLLECTIVE BARGAINING IDENTIFICATION ‑ UNIT AND CLASS NUMBER
If the Candidate/Employee is a member of faculty, management, professional, or special payroll, type "Board of Trustees Exclusion, "otherwise the Bargaining Unit under which the Candidate/Employee is covered.

(18) DATE
The date signed by the Candidate/Employee.

(19) PAYEE'S TITLE
The Candidate/Employee's new Job Title, Department and telephone extension.

(20) PAYEE'S SIGNATURE
This must be the original signature of the Candidate/Employee.

(21) ADVANCE FROM PETTY CASH - AMOUNT
Leave blank.

(22) PAYEE'S SIGNATURE
Leave blank.

(23) REMARKS, EXPLANATION OF UNUSUAL ITEMS, ETC.
Type: “To reimburse (name of Candidate/ Employee) for moving expenses from (City and State) to (City and State) on (date). This expense is in connection with (name of Candidate/ Employee) assuming the (Title of Position) in the (Department Name) Department, and was recommended to and approved by the BOT at its meeting on (date). A copy of this approval is attached and is supportive of Public Act #82.218 and enacted under Section 10a-108 of the General Statutes.”

Note: Department Head Approval - The authorized signature of the Department Head, Dean, Hospital Director, Senior Vice Chancellor, Vice Chancellor, Associate Vice President and/or Assistant Vice President should appear in the lower right-hand corner of block #23.

(24)
Leave Blank.

(25)
Leave Blank.

(26)
Leave Blank.

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

(28) AGENCY
The agency is 7302.

(29) - (34) COST CENTER, OBJECT, AGENCY TAIL AND FY
The Account Number coding and the Fiscal Year where the expended amount is to be charged. The coding must be exactly as it appears on the approved Candidate/Employee Moving Expense Requisition.

Employee Expenditures

(35) DATE
The beginning date on which the moving expenses were incurred, must be listed separately.

(36) TRAVEL ‑ FROM/ TO
The name of the cities FROM which you have moved, and TO which you have moved.

(37) TIME ‑ DEPART./ ARRIVE
The departure time from city of departure, and arrival time when arriving at your destination.

(38) TRAVEL BY AUTOMOBILE
If personal vehicle was used, check  PERSONAL VEHICLE

• Personal Vehicle: When using your personally owned vehicle, record the number of miles, the appropriate rate allowed per mile, and the dollar amount to be reimbursed.

Note: A copy of a current car insurance policy, showing a minimum liability coverage of $50,000 / $100,000 and $5,000 in property damage - or - , in lieu thereof, a minimum of $100,000 for liability for bodily injury and property damage, must be attached to the Employee Voucher Form CO-17XP.

(39) OTHER TRAVEL
Indicate other forms of transportation, other than personal mileage, by the appropriate code (B‑Bus, R‑Rail, C‑Cab, O‑Other). Indicate the amount to be reimbursed next to the code letter. Each ride should be listed separately. If the employee has received approval on the Travel Authorization to personally purchase an airline ticket and be reimbursed for it, code "O" should be used. Receipts must be attached to the Employee Voucher for Bus, Rail, Other (airline ticket), cabs and limos in excess of twenty-five dollars ($25.00) per ride.

(40) LODGING
Accommodation expense must be listed by day, each on a separate line. Room tax is not included in this amount. Room Tax must be listed under #42 "Miscellaneous Expenses.” The itemized hotel bill must be attached to the Employee Voucher, showing the hotel's name, the individual's name, the date(s) the individual stayed at the hotel, and the rate charged per day.

(41) MEALS
The total meal allowance amount, including applicable taxes. (See the Maximum Allowable Moving Expense Schedule)

(42) MISCELLANEOUS EXPENSES
The following miscellaneous expenses must be itemized:

• Room Tax: Amount as appeared on the hotel bill, if any.
• Occupancy Tax: Amount as appeared on the hotel bill, if any.
• Meal Tax: Leave Blank.
• Gratuities on Meals: Leave Blank.
• Lump Sum: Leave Blank.
• Telephone: Leave Blank.
• Car Rental: Leave Blank.
• Tolls: Only the actual expense incurred is reimbursable. Receipts are required.
• Parking: Only the actual expense incurred is reimbursable. Receipts are required.
• Other: Any other miscellaneous expense which is not categorized on the Employee Voucher must be listed in the miscellaneous column. Only the actual expense incurred is reimbursable. Receipts are required.
• Sub Totals: Sub‑total each column of travel expenses.
• Grand Total: The grand total of the travel expense reimbursement amount must be the same as the Document Amount in #5.

(43) AGENCY
The University of Connecticut Health Center.

(44) T.A. NO.
Leave blank.

45. FROM/ TO DATES
The departure date from previous residence and the arrival date at destination in Connecticut.

For General Accounting Office Use Only

Agency Certification

(46) DATE APPROVED
The date that the Employee Voucher is approved by Accounts Payable.

(47) AMOUNT APPROVED
The reimbursement amount approved by Accounts Payable and General Accounting.

(48) SIGNATURE - HEAD OF EXPENDING AGENCY
Signed by the authorized Accounts Payable and General Accounting personnel.