ARS-209P OSQR Expense Report (Travel Expense)

OSQR Travel Expense Report

Please print all information required on this form; attach all receipts (except meals), original hotel bill, and airline ticket receipt; and return to the OSQR within 10 days following your travel. If you have any questions, please contact OSQR at 301-504-3282.

Full Name:_____________________________________________

Address ___________________________________________________________________

(to which check

will be mailed) ___________________________________________________________________

DEPARTURE AND RETURN

Departed Home/Office (date): ______________________________________________________

Returned Home/Office (date): ______________________________________________________

GROUND TRANSPORTATION

From Home/Office to Local Airport $_______ or _____miles @ ____¢/mile_______ (for personal vehicle)

From Airport to Hotel $_______ Taxi, Metro, Shuttle, Other Public Transportation

From Hotel to Airport $_______ Taxi, Metro, Shuttle, Other Public Transportation

From Local Airport to Home/Office $_______ or _____miles @ ____/mile_______ (for personal vehicle)

Parking at Home Airport $_______ if $___ or more, receipt is required

Tolls $_______

HOTEL EXPENSES – Original Receipt Must Be Submitted

Total Room Charge $_______ Do not include any meal expenses

(a per diem amount is provided for meals)

OTHER EXPENSES

Item Description: ________________________________________ $__________________

Item Description: ________________________________________ $__________________

For any expense that is $____ or more, the original receipt must be submitted.

Public Burden Statement: According to the Paperwork Reduction Act of 1995, an Agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB number. The valid OMB control number for this information collection is 0518-0028. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

United States Department of Agriculture, Agricultural Research Service, Office of Scientific Quality Review

5601 Sunnyside Avenue, Beltsville, Maryland 20705

301-504-3282

ARS-209P xx/xx/xxxx