Expense Claim for Travel

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Location and Date of Activity/Event

Transportation

Personal Vehicle Miles @ $0.56 per mile (include mileage both directions) and/or Taxi Fare (receipt required if over $10) and/or Commercial Fares (Itemized receipt required)

Registration Fee (Receipt Required)

Enter amount total for Registration Fee

Meals (Not included in registration fee - no receipts please)

The maximum meal allowance for each quarter: $ 7.00 1st qtr. 6:00 am to 12:00 pm (20%) $10.50 2nd qtr. 12:00 pm to 6:00 pm (30% $17.50 3rd qtr. 6:00 pm to 12:00 am (50%) $35.00 Max. per day reimbursement for meals

Lodging (Itemized receipt required)

Enter amount total for lodging.

Miscellaneous Expenses (receipt required)

Price: $ 0.00

 All allowable travel expenses (other than meal per diem) greater than $10 must be documented with itemized receipts (luggage, taxi etc.)  Parking fees at a motel/hotel or an airport require a receipt and will only be reimbursed for overnight travel.

Miscellaneous Expenses (receipt required)

Upload All Receipts Here

Click or drag files to this area to upload. You can upload up to 20 files.

There are several ways to take images of your receipts for easy submission. We recommend downloading the Simple Scan App to your phone which is free and allows you to create a folder of pictures of receipts and the file can be stored on your computer and uploaded here. Again, there are are other ways so upload the files they way that is easiest for you>

Certification

I certify that this itemized statement representing a claim for fees, travel expenses and miscellaneous costs, or combination thereof, truthfully and accurately describes the services rendered, the days of service, and travel related expenses; and that the amount of payment will not be duplicated from any other source.

Signature

Per Diem (Meal Allowance)

A contractor shall be reimbursed per diem for meals paid by the contractor while traveling at the request of Certification Central,
up to the allowable rates established below (meal receipts are not required.) A contractor will not be reimbursed for the
first quarter if travel began after 7:00 a.m. In order to claim expenses for the second and third quarters, the contractor
must have been in travel status one hour before the start of the quarter being claimed, and travel status must extend at
least one hour into the quarter being claimed. No meals are reimbursed if total travel status is less than 4 hours. Meals
in the city of residence/employment and meals provided by a conference are not reimbursable.

Per Diem for travel within North Dakota
$ 7.00 1st qtr. 6:00 am to 12:00 pm (20%)
$10.50 2nd qtr. 12:00 pm to 6:00 pm (30%)
$17.50 3rd qtr. 6:00 pm to 12:00 am (50%)
$17.50 3rd qtr. 6:00 pm to 12:00 am (50%)

Lodging

Copies of itemized lodging receipts are required. Certification Central will not reimburse incidental expenses (e.g., movies, phone, etc.),
however, applicable taxes are reimbursed. Travelers need to exercise diligence in securing hotel rooms at the best
possible rate.

Transportation

• Effective January 1, 2021, in-state mileage for personal car use is reimbursed at $.56 per mile both ways.
• Reimbursements for airline ticket or other travel must be specified in the contract. Contractor will be
reimbursed for coach class tickets and must exercise diligence in securing the best possible rates. Receipts
showing flight itinerary are required.
• Luggage fee will be reimbursed only for the first piece of checked luggage unless specified in the contract.
• Car rental is not an allowable expense.

Miscellaneous

• All allowable travel expenses (other than meal per diem) greater than $10 must be documented with itemized
receipts (luggage, taxi etc.)
• Parking fees at a motel/hotel or an airport require a receipt and will only be reimbursed for overnight travel.
• Contractors are requested to submit reimbursement claims within 30 days of travel.