Form NRC Form 64, Form NRC Form 64, Form NRC Form 64, Travel Voucher

PRIVACY ACT STATEMENT

NRC Form 64 Travel Voucher (Part 1);
NRC Form 64A Travel Voucher (Part 2) Schedule of Expenses and Amount Claimed;
NRC Form 64B Optional Travel Voucher (Part 2) Expense Report
Pursuant to 5 U.S.C. 552a(e)(3), enacted into law by Section 3 of the Privacy Act of 1974 (Public Law 93-579),
the following statement is furnished to individuals who supply information to the U.S. Nuclear Regulatory
Commission (NRC) on NRC Form 64, 64A, and 64B. This information is maintained in a system of records
designated as NRC-20 and described at 77 Federal Register 67218 (November 8, 2012), or the most recent
Federal Register publication of the NRC's Systems of Records Notices that is located in NRC's Agencywide
Documents Access and Management System.
1.

AUTHORITY: 5 U.S.C. Part III, Subpart D, Chapter 57; 31 U.S.C. 716; 41 U.S.C. Subtitle II, Chapter
61; 41 CFR 102-118; Executive Order (E.O.) 9397, as amended by E.O. 13478.

2.

PRINCIPAL PURPOSE(S): To make reimbursement claims for approved and authorized travel
expenses, per diem, and other change of station expenses.

3.

ROUTINE USE(S): In addition to the disclosures permitted under subsection (b) of the Privacy Act (5 U.S.C.
552a), the NRC may disclose information contained in this system of records without your consent to the
U.S. Treasury to secure payments; to the Department of State or an embassy for passports or visas; to GSA
and OMB for required periodic reporting; to charge card issuing bank; to Dept. of Interior/NBC for collecting
severe travel card delinquencies by employee salary offset; and to consumer reporting agency to obtain
credit reports. The information may also be disclosed to an appropriate Federal, State, local or Foreign
agency in the event the information indicates a violation or potential violation of law; in the course of an
administrative or judicial proceeding; to an appropriate Federal, State, local and Foreign agency to the extent
relevant and necessary for an NRC decision about you or to the extent relevant and necessary for that
agency's decision about you; in the course of discovery under a protective order issued by a court of
competent jurisdiction, and in presenting evidence; to a Congressional office to respond to their inquiry made
at your request; to NRC-paid experts, consultants, and others under contract with the NRC, on a
need-to-know basis; and to appropriate persons and entities for purposes of response and remedial efforts in
the event of a suspected or confirmed breach of data from this system of records.

4.

WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT
PROVIDING INFORMATION: Disclosure is voluntary. However, if the requested information is not provided,
reimbursement may be denied. Failure to provide the last four digits of your Social Security number (SSN)
may result in delayed processing. The use of the SSN is necessary because of the large number of present
and former Federal employees and applicants who have identical names and birth dates, and whose
identities can only be distinguished by the use of this number.

5.

SYSTEM MANAGER AND ADDRESS: Chief, Financial Operations Branch, Division of the Controller, Office
of the Chief Financial Officer, U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001.

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 64

(MM-YYYY)
NRCMD 14.1
Exception to SF 1012
Approved by NARS 10-81

APPROVED BY OMB: NO. 3150-0192

TRAVEL VOUCHER (PART 1)
FOLLOW INSTRUCTIONS

1. AUTHORIZATION NUMBER

2. SOCIAL SECURITY
NO. (Last 4 digits)

2a. NON-NRC SSN
(9 digits)
4. OFFICE TELEPHONE

3. NAME (Last , First, Middle Initial)

EXPIRES: (MM/DD/YYYY)

Estimated burden per response to comply with this voluntary collection request: 1
hour for NRC Forms 64 and 64A or 64B. NRC uses the information to authorize
payment for official travel. Forward comments regarding burden estimate to the
FOIA, Privacy, and Information Collections Branch (T-5 F53), U.S. Nuclear
Regulatory Commission, Washington, DC 20555-0001, or by e-mail to
[email protected], and to the Desk Officer, Office of Information and
Regulatory Affairs, NEOB-10202, (3150-0192), Office of Management and
Budget, Washington, DC 20503. If a means used to impose an information
collection does not display a currently valid OMB control number, the NRC may
not conduct or sponsor, and a person is not required to respond to, the information
collection.
6. RECLAIM VOUCHER

5. MAILING ADDRESS (Include ZIP Code)

YES

NO

7. VOUCHER STATUS
PARTIAL

FINAL

8. TRAVEL PERIOD(S)
A. FROM (MM/DD/YYYY)
9. OFFICIAL DUTY STATION (City and State)(drop down list or fill in)

B. TO (MM/DD/YYYY)

10. RESIDENCE (City and State)
11. LEAVE TAKEN

13. TYPE OF TRAVEL

14. METHOD OF PAYMENT
HEADQUARTERS TO BE PAID BY EFT

CONUS/DOMESTIC
FOREIGN

17. TRANSPORTATION METHOD OF PAYMENT
GTR/GTS ACCT/GOVT ISSUED CARD/CASH
(Identify below)

OTHER

OTHER PREMIUM CLASS

16. EXPENSES CLAIMED
(FROM NRC FORM 64A OR NRC FORM 64B)

FREE UPGRADE

OTHER

COS

NON-CONTRACT
19. TRANSPORTATION
GTR OR TICKET
NUMBER

18. CARRIER

12. COMPARATIVE
TRAVEL

SICK

FIRST CLASS

EFT PAYMENT TO
ALTERNATE ACCOUNT

NONFOREIGN OUTSIDE CONUS

ANNUAL

15. AIRLINE ACCOMMODATIONS

EXPENSES
20. AMOUNT

AMOUNT CLAIMED
OTHER EXPENSES

A. SUBSISTENCE AND
OTHER EXPENSES

$0.00

B. PLANE, TRAIN, BUS
(PAID BY TRAVELER)
21. TRAVELER'S CERTIFICATION. I HEREBY ASSIGN TO THE UNITED STATES ANY RIGHT I MAY HAVE AGAINST ANY
PARTIES IN CONNECTION WITH REIMBURSABLE TRANSPORTATION CHARGES DESCRIBED ABOVE, PURCHASED
UNDER CASH PAYMENT PROCEDURES.

TRAVELER'S
INITIALS

23. TRAVEL ADVANCE

22. READ CAREFULLY
(If voucher includes any of the following, mark the appropriate boxes.)

TOTAL ADVANCE RECEIVED (Traveler Must Complete)

REFUND DUE ON UNUSED TICKET, PARTIAL TICKET, AND/OR REFUND SLIP
(Explain in Part 2 and attach to front of voucher)
REMITTANCE ATTACHED IN THE
AMOUNT OF:
24.

$0.00

C. TOTAL CLAIM

ATM
CHECK NO.

$

I CERTIFY THAT THIS VOUCHER IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND
BELIEF AND THAT PAYMENT OR CREDIT HAS NOT BEEN RECEIVED BY ME.

OTHER

FOR EXAMINER USE

DATE

AMOUNT TO BE APPLIED

SIGNATURE -- TRAVELER*

BALANCE DUE

Printed Name of Traveler:
DATE

25. THIS VOUCHER IS APPROVED.

NET TO TRAVELER

SIGNATURE -- APPROVING OFFICIAL

26. EXAMINER'S ADJUSTMENTS

Printed Name of Approving Official:
27. TRAVELER DESIGNATION
TO RECEIVE CASH PAYMENT OF THIS TRAVEL VOUCHER. I ACCEPT
I DESIGNATE
RESPONSIBILITY FOR THE PAYMENT ONCE THE IMPREST FUND CASHIER PROPERLY DISBURSES THE CASH TO MY DESIGNEE.
SIGNATURE -- TRAVELER

DATE
EXAMINED BY

DATE

28. CASH PAYMENT OF TRAVEL VOUCHER (For Cashier Use)
RECEIVED CASH IN

FOR

29. THIS VOUCHER IS CERTIFIED CORRECT AND
PROPER FOR PAYMENT

THE AMOUNT OF: $
SIGNATURE

DATE

NRC BADGE NUMBER

SIGNATURE -- AUTHORIZED CERTIFYING OFFICER

DATE

30. ACCOUNTING CLASSIFICATION (For Division of Financial Services Use)
A.
COST

B.
PURPOSE
CODE

C.
BFY

D. COST
ORGANIZATION
CODE

E.
JOB
CODE

F. (2110-S)
SUBSISTENCE
AND OTHER

G. (2120-D)
COMMON
CARRIER

H.
TOTAL

DOMESTIC

FOREIGN

* Fraudulent Claim -- Falsification of an item in an expense account works a forf eiture of the Claim (28 U.S.C. 2514) and may result in a fine of not more than $10,000 or imprisonment of not more than
5 years or both (18 U.S.C. 287; id. 1001)

NRC FORM 64 (MM-YYYY)
TRAVELER'S COPY

ADVANCE COPY

MEMORANDUM

AUTHORIZATION

AUDIT

FUNDS CONTROL

PAGE
U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 64A
(MM-YYYY)
NRCMD 14.1
Exception to SF 1012
Approved by NARS 10-81

TRAVEL VOUCHER (PART 2)
SCHEDULE OF EXPENSES AND AMOUNT CLAIMED
FOLLOW INSTRUCTIONS

NAME (Last, First, MI)

APPROVED BY OMB: NO. 3150-0192

OF
EXPIRES: (MM/DD/YYYY)

Estimated burden per response to comply with this voluntary collection request: 1 hour for
NRC Forms 64 and 64A or 64B. NRC uses the information to authorize payment for official
travel. Forward comments regarding burden estimate to the FOIA, Privacy, and Information
Collections Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC
20555-0001, or by e-mail to [email protected], and to the Desk Officer, Office
of Information and Regulatory Affairs, NEOB-10202, (3150-0192), Office of Management and
Budget, Washington, DC 20503. If a means used to impose an information collection does
not display a currently valid OMB control number, the NRC may not conduct or sponsor, and
a person is not required to respond to, the information collection.

AUTHORIZATION NO.

DEPART FROM OFFICE
DATE (MM/DD/YYYY)

TIME (ie. 1:00)
A.M.
P.M.

DATE
20

AUTHORIZED
MILEAGE (ie.50)

NATURE OF EXPENSE

¢

NUMBER
OF
MILES

AMOUNT
CLAIMED

GRAND TOTAL - THIS PAGE

NRC FORM 64A (MM-YYYY)

(Amount to be included in Item 16.C, Part 1)
TRAVELER'S COPY

ADVANCE COPY

MEMORANDUM

AUTHORIZATION

AUDIT

FUNDS CONTROL

PAGE
(MM-YYYY)
NRCMD 14.1
Exception to SF 1012
Approved by NARS 10-81

OF

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 64A

TRAVEL VOUCHER (PART 2)
SCHEDULE OF EXPENSES AND AMOUNT CLAIMED
FOLLOW INSTRUCTIONS

NAME (Last, First, MI)

AUTHORIZATION NO.

DEPART FROM OFFICE
DATE (MM/DD/YYYY)

TIME (ie. 1:00)
A.M.
P.M.

DATE
20

AUTHORIZED
MILEAGE (ie.50)

NATURE OF EXPENSE

¢

NUMBER
OF
MILES

AMOUNT
CLAIMED

GRAND TOTAL - THIS PAGE

NRC FORM 64A (MM-YYYY)

(Amount to be included in Item 16.C, Part 1)
TRAVELER'S COPY

ADVANCE COPY

MEMORANDUM

AUTHORIZATION

AUDIT

FUNDS CONTROL

PAGE
U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 64B
(MM-YYYY)
NRCMD 14.1
Exception to SF 1012
Approved by NARS 10-81

OPTIONAL TRAVEL VOUCHER (PART 2)
EXPENSE REPORT
FOLLOW INSTRUCTIONS

AUTHORIZATION
NUMBER

POV MILEAGE RATE
CENTS/MILE
(ie .50)

(NRC Form 64B can be used in lieu of NRC Form 64A.)
NAME OF EMPLOYEE (Last, First, MI)

DEPARTURE FROM
OFFICE

OF

EXPIRES: (MM/DD/YYYY)

APPROVED BY OMB: NO. 3150-0192

Estimated burden per response to comply with this voluntary collection request: 1 hour for NRC
Forms 64 and 64A or 64B. NRC uses the information to authorize payment for official travel.
Forward comments regarding burden estimate to the FOIA, Privacy, and Information Collections
Branch (T-5 F53), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by
e-mail to [email protected], and to the Desk Officer, Office of Information and
Regulatory Affairs, NEOB-10202, (3150-0192), Office of Management and Budget, Washington,
DC 20503. If a means used to impose an information collection does not display a currently
valid OMB control number, the NRC may not conduct or sponsor, and a person is not required
to respond to, the information collection.

DATE

TIME (ie. 1:00)

A.M.
P.M.

A. LOCAL TRANSPORTATION TO COMMON CARRIER TERMINAL
DATE

MODE

POV MILEAGE

WHERE USED

COST OF TRIP
$

0.00

$

0.00 $

A. TOTAL

0.00

B. ITINERARY
DEPARTURE DATE
(MM/DD/YYYY)
CITY/STATE
TIME
(SPECIFY A.M. OR P.M.)

A.M.

A.M.

A.M.

A.M.

A.M.

P.M.

P.M.

P.M.

P.M.

P.M.

A.M.

A.M.

A.M.

A.M.

A.M.

P.M.

P.M.

P.M.

P.M.

P.M.

ARRIVAL DATE
(MM/DD/YYYY)

IF ADDITIONAL SPACE
IS REQUIRED, USE
CONTINUATION PAGES.

CITY/STATE
TIME
(SPECIFY A.M. OR P.M.)

C. MILEAGE -- P.O.V.
NUMBER OF MILES

¢

@

C. TOTAL
$

0.00

0.00

$

0.00

$

$

0.00

0.00

0.00 $

$

D. PER DIEM OR ACTUAL SUBSISTENCE (check box if per diem -- do not check if actual)
ACTUAL LODGING

$

$

$

$

$

MEALS & INCIDENTAL
EXPENSES

$

$

$

$

$

LESS PREPAID
MEALS/LODGING

$

$

$

$

$

TOTAL DAILY
PER DIEM $

$

$

$

$

$

D. TOTAL

TOTAL DAILY ACTUAL SUBSISTENCE NTE $

$

$

$

$

$

$

STATE SPECIFIC PREPAID
MEALS (B/L/D)OR LODGING

0.00

E. OTHER EXPENSES (List)
$

$

$

$

$

$

$

$

$

$

E. TOTAL

$

$

$

$

$

$

0.00

F. LOCAL TRANSPORTATION AT TEMPORARY DUTY STATION
CAR RENTAL
(PAID BY TRAVELER)
DATE

$
MODE

$
POV MILEAGE

$

$

$

WHERE USED

COST OF TRIP
$

F. TOTAL

$

$

G. LOCAL RETURN TRANSPORTATION TO OFFICE OR OFFICIAL DUTY STATION FROM COMMON CARRIER TERMINAL
DATE

MODE

POV MILEAGE

WHERE USED

COST OF TRIP
$

0.00

$

0.00 $

0.00

$

0.00

TOTAL CLAIM - THIS PAGE (A-G) -- TO BE INCLUDED IN ITEM 16A ON NRC FORM 64.
PLANE, TRAIN, BUS (PAID BY TRAVELER) - THIS PAGE -- TO BE INCLUDED IN ITEM 16B ON NRC
FORM 64.
GRAND TOTAL - THIS PAGE -- TO BE INCLUDED IN ITEM 16C ON NRC FORM 64.

G. TOTAL

$
$

0.00

NRC FORM 64B (MM-YYYY)
TRAVELER'S COPY

ADVANCE COPY

MEMORANDUM

AUTHORIZATION

AUDIT

FUNDS CONTROL

INSTRUCTIONS FOR COMPLETING NRC FORM 64, TRAVEL VOUCHERS (PART 1)
Type or handwrite this form using the instructions below. Ensure that all copies are legible. The traveler must initial any
erasures and alterations in totals on the voucher. An electronic version of this form is also available in InForms.
1. Authorization Number. Enter the Authorization
Number from NRC Form 279, "Official Travel
Authorization," Item No. 3.
2. Social Security No. (Last 4 digits) Provide the last
4 digits of the traveler's Social Security Number.
3. Name. Provide traveler's name using the surname,
first name, and middle initial.
4. Office Telephone. Indicate the traveler's office
telephone number.

14.

Method of Payment. Enter the method of payment
for reimbursement of travel expenses.

15.

Airline Accommodations. Check all classes of
service that were authorized for the travel.

16.

Expenses Claimed. Enter the appropriate amounts
from NRC Form 64A or NRC Form 64B.

17. - 20.
Leave blank unless traveler purchased tickets using
a Government-issued charge card or cash (under
$100 or emergencies only) as documentation
required).

5. Mailing Address. Insert the address where
reimbursement is to be sent. If office address is
used, indicate mail stop.
6. Reclaim Voucher. Place an "X" in the appropriate
block.

21.

7. Voucher Status. Applies to vouchers submitted
against "Blanket" or "Change of Station"
authorizations only. If more than one voucher will be
submitted, place an "X" in the "Partial" box. Place
an "X" in the "Final" box when the last voucher is
submitted.

Traveler's Certification. The General Services
Administration (GSA) audits tickets purchased with
cash. This certification permits the Government to
recover any excess charges by carriers. Initial the
certification if applicable.

22.

Read Carefully. Mark the appropriate boxes and
follow the instructions provided.

8. Travel Period(s). Insert at "A." the date that travel
started (MM/DD/YYYY) and insert at "B." the date
that travel ended (MM/DD/YYYY).

23.

9. Official Duty Station. Indicate the place of the
traveler's designated headquarters or official station.
Enter "Consultant" for consultant travel or
"Invitational" for invitational travel.

Travel Advance. Traveler must provide the amount
of advance received. Voucher Examiner will
complete the remaining portions of Item 23.

24.

Signature - Traveler. Traveler must sign and date
in ink. The voucher shall not be signed by anyone
for the traveler.

10. Residence. Enter city and state of residence from
which employee commutes to work if different from
the address shown in Item 7.

25.

Signature - Approving Official. Approving official
must sign and date in ink.

11. Leave Taken. If travel is interrupted, specify annual,
sick, or other type of leave taken during the period of
travel.

26.

Examiner's Adjustments. Leave Blank.

27.

12. Comparative Travel. Place an "X" if actual travel is
a result of personal preference rather than what is
officially authorized. To determine whether travel
was beneficial to the Government, specific details of
travel must be reconstructed on Part 2 (i.e. details
must compare actual travel with travel that was
officially authorized).

Traveler Designation. The traveler shall designate
the person to whom cash payment shall be made
and sign and date the designation.

28.

Cash Payment of Travel Voucher. Leave Blank.

29.

Signature - Authorized Certifying Officer. Leave
Blank.

30.

Accounting Classification. Leave Blank.

13. Type of Travel. Enter the type of travel performed,
e.g. Continental United States (CONUS/Domestic),
nonforeign outside CONUS (includes the States of
Alaska and Hawaii, the Commonwealths of Puerto
Rico and the Northern Mariana Islands, and the
territories and possessions of the United States),
foreign, or change of station (COS).

INSTRUCTIONS FOR COMPLETING NRC FORM 64A, TRAVEL VOUCHERS (PART 2)
This form is an attachment to NRC Form 64 (Part 1). Type or handwrite this form using the instructions below. Ensure
all copies are legible. An electronic version of this form is also available in InForms
1. Per Diem. (Continued)
The total may not exceed the authorized rate of
per diem. Also see Section 6.1.2.3 of Part 6 for
the amounts to be deducted for each meal and/or
lodging that is provided by the government at no
B. Authorization Number. Enter the authorization number
cost to the traveler.
and the traveler's name for which the voucher applies.
2. Actual Subsistence. Show the actual lodging
Also, enter date and time of traveler's departure date.
cost. Itemize daily expenses for breakfast, lunch,
dinner, tips, etc. when the actual subsistence
C. Itemization.
authority provides for higher costs for these items.
(See NRCMD 14.1, Part 6). The total may not
1. General. Show the details of the expenses actually
exceed the authorized actual subsistence rate.
incurred. Official local telephone calls; parking
meter fees; and local streetcar, bus, and subway
F. Explanations Required.
charges may be summarized for the trip. The
summarized amounts must be itemized if the total
1. Cash Purchase of transportation tickets.
for each summarized item exceeds $75.
2. Taking of leave of any kind.
2. Chronological Order. Itemize expenses incurred
in chronological order.
3. Interruption of travel for emergency or personal
reasons.
3. Leave of Absence. When leave of any kind is taken,
show the exact hour of departure from and return to
4. Indirect travel for personal reasons
duty status, along with the total amount of leave used.
5. Delays at places other than duty posts.
A. Page Number. Enter page number, starting with Page
"1." If additional pages of this form are required, enter
Page "2," "3," etc. as appropriate, on each succeeding
page.

6. Mileage claimed is greater than mileage of a
4. ATM Transaction Fees and Bank Surcharges.
usually traveled route.
These fees may be claimed as long as the total
advance amount withdrawn did not exceed the
7. Use of a rental vehicle or other special means of
amount of the authorized travel advance. Fees that
transportation when it was not authorized on NRC
are unknown at the time the original voucher is
for 279, "Official Travel Authorization."
prepared may subsequently be claimed on a travel
G. Foreign Travel.
voucher or local travel voucher. (When a trip is
canceled and the advance was obtained within three
1. Itemize expenditures by items in the currency in
business days of the scheduled departure date,
which the expenditures were made.
claim the ATM transaction fee on SF-1164. (See
Convert total foreign expenditures into U.S. dollars
2.
NRCMD 14.1, Exhibit 2.1.)
at rate or rates at which the foreign currency was
D. Transportation.
obtained.
3. Show rates of conversions and commissions
1. Departure and arrival. Indicate the actual
charged.
departure date from home or office, and the mode of
transportation used, e.g., POV, limo, taxi, etc.
H. Attachments. (Staple to left side of Original Copy of
Page 1 of this form.)
2. Common Carrier. Indicate location (city/state) of
1. Passenger coupon copy of tickets that were used.
departure terminal and arrival terminal and method
(Attach unused tickets or portions of unused
of transportation used.
tickets to the front of NRC Form 64 if they have
3. Mileage. Insert mileage rate authorized. List
not been returned previously to the headquarters
number of miles between various points for which
or region travel office.) Do not attach boarding
mileage will be claimed. Indicate amount claimed
passes or ticket folders.
for mileage. This may be done by showing the
Receipts are required for all lodgings. They are
2.
amount involved (number of miles times rate per
also required for itemized cash expenses over $75
mile) between different points.
as specified in NRCMD 14.1, Exhibit 7.1.
4. Rental Vehicle and Other Special Means of
3. A foreign flag certification (See NRCMD 14.1,
Transportation. Show dates and points of travel,
Exhibit 4.3) which provides the justification for a
kinds of transportation used, and the amount
traveler's use of a foreign flag carrier for any part
claimed.
of foreign travel.
5. Cash Payment for Common Carrier Fare. If
I. Erasures and Alterations. Traveler must initial
common carrier was procured fro the traveler's
alterations in totals. Erasures and alterations in totals
personal funds, show amount spent, including any
on receipts must be initialed by person who signed
Federal transportation tax, mode, and class of
receipt. To correct errors on vouchers, draw a line
transportation used.
through the error and initial the correction. Do not
erase
E. Per Diem/Actual Subsistence.
J. Comparative Cost Statements. Prepare Comparative
Cost Statements to reflect costs that would have been
1. Per Diem. Show the actual lodging cost and meals
incurred had the travel been accomplished by the most
and incidental expenses (M&IE) rate for each day
expeditious means. An example of a cost comparison
for which per diem is claimed. (See NRCMD 14.1,
statement is shown in NRCMD 14.1., Exhibit 7.4.
Part 6).

INSTRUCTIONS FOR COMPLETING NRC FORM 64B, OPTIONAL TRAVEL VOUCHERS (PART 2)
This is an optional form and is an attachment to NRC Form 64, (Part 1), in lieu of NRC Form 64A and can be typed or
handwritten using the instructions below. Ensure all copies are legible. When this form is prepared, the traveler must
initial the change if an alteration is made to the "Grand Total". To correct an error, draw a line through the error and initial
the correction.
This "Expense Report" is used as a log to record the traveler's expenses on a daily basis. It is designed to allow entry for
up to 5 days travel expenses. Use additional forms if your travel exceeds 5 days or when a cost comparison is required.
Note: When travel is performed in one duty location for several consecutive days and reimbursement is under the
lodgings-plus per diem system, the traveler may record the first and last days of travel in separate columns (to
accommodate quarter-day computations for M&IE rate) and consolidate all interim days in one column.
Record each expense that applies to that day's travel. Upon completion of all daily expenses, show the cumulative totals
for each type of expense in the "Totals" column on the far right of the form.
A. Local Transportation to Common Carrier Terminal.
Complete the appropriate blocks for the transportation
that the traveler used to get to a common carrier
terminal and enter the total at "A. Total".
B. Itinerary.
Depart:

E. Other Expenses. Use this space to list ATM
transaction fees and bank surcharges, communication
services, baggage, supplies, and other authorized
miscellaneous expenses. Official local telephone calls
may be summarized for the trip unless they exceed $75.

Enter date.
Enter city and state of the departure
location.

F. Local Transportation at Temporary Duty Station.
Enter the amount paid for authorized car rental. Show
the amount for the day the car is turned in. A receipt is
not required unless the rental car cost exceeds $75.
Arrive:
Enter date.
Complete the appropriate blocks when transportation
Enter travel location for each day of travel.
was by other than car rental. Local streetcar, bus and
subway charges; and parking meter fees may be
Use
this
space
only
if
the
traveler
is
C. Mileage.
summarized for the trip unless the total for each
authorized a privately owned vehicle (POV) for the
summarized item exceeds $75.
entire trip. Enter the number of miles traveled on a daily
basis on the first line. Enter the authorized mileage rate
G. Local Return Transportation to Office or Official
for reimbursement and the resulting cost on line 2.
Duty Station From Common Carrier Terminal.
Complete the appropriate blocks for the transportation
D. Per Diem or Actual Subsistence.
the traveler used to return to the office or residence
from a common carrier terminal. If costs for parking
Actual Lodging. Enter the actual amount paid for
were incurred, include in this space.
lodging. A receipt is required.
Meals and Incidental Expenses. Enter the meals and Complete remaining "TOTALS" as noted on the form.
incidental rate (M&IE) for the locality. Use 3/4 of the
applicable M&IE rate for the first and last days of travel H. Attachments. (Staple to left side of Original Copy of
Page 1 of this form.)
under lodgings plus per diem system.
Less Prepaid Meals/Lodging. Enter amounts to be
deducted for meals/lodging that were included in
registration fees, tuition, furnished to the traveler at no
cost, etc.
State Specific Prepaid Meals (Breakfast, Lunch,
Dinner) or Lodging. Identify each item, and the
quantity of each, that is calculated in the deduction
amount.
Total Daily Per Diem NTE. Use this block if per diem
reimbursement was authorized. Enter the total of the
lodging and M&IE up to the authorized per diem for
each day.
Total Daily Actual Subsistence NTE. Use this block if
actual subsistence was authorized for lodgings plus the
applicable locality rate for M&IE. Enter the total of the
lodging and M&IE up to the authorized actual
subsistence amount. (If the actual subsistence
authorization included actual meals and incidental
expenses, use NRC Form 64A to claim travel expenses
or itemize the meals and incidental expenses such as
dry cleaning, coin-operated laundries, baggage
handlers, etc. in "Other Expenses".)
If the "Other Expenses" column is used for this
purpose, be sure to include the total at Item D. instead
fIt
E

1. Passenger coupon copy of tickets that were used.
(Attach unused tickets or portions of unused
tickets to the front of NRC Form 64 if they have not
been returned previously to the headquarters or
region travel office.) Do not attach boarding
passes or ticket folders.
2. Receipts are required for all lodgings. They are
also required for itemized cash expenses over $75
as specified in NRCMD 14.1, Exhibit 7.1.