TRAVEL VOUCHER (Relocation)
SECTION A -- IDENTIFICATION
1. TRAVEL AUTHORIZATION NO.
2. SOCIAL SECURITY NO.
3. NAME (Last)
(Middle Initial) 4. AGENCY
5. AGENCY ORIGINATING OFFICE
6. TRAVELER ORIGINATING
7. DATES OF TRAVEL EXPENSES
8. TYPE CLAIM (Indicate one type only)
= Trans Stn
= Relo Contr
SECTION B -- TRAVEL VOUCHER MAILING ADDRESS OPTIONS
SECTION E -- ACCOUNTING CLASSIFICATION
SECTION F -- CERTIFICATION
FRAUDULENT CLAIM. Falsification of an item in an expense account will result in a forfeiture of the claim (28 USC
2514) and may result in a fine of not more than $10,000 or imprisonment for not more than 5 years or both (18 USC 287; i.d.
CLAIMANT'S RESPONSIBILITIES AND SIGNATURE. I hereby assign to the United States any rights I may have
against other parties in connection with any reimbursable carrier transportation charges described herein. I have received no
payment for claims shown herein. All travel and reimbursable claims were incurred on official business of the United States
Government. All tickets, coupons, promotional items and credits received in connection with travel claimed on this voucher
have been accounted for as required by FPMR 101-7 and other regulations. I have reviewed this voucher and certify it to be
52. CLAIMANT'S SIGNATURE
APPROVING OFFICER'S RESPONSIBILITIES AND SIGNATURE. In approving this voucher, I have determined that: (1)
Reimbursement is claimed for official travel only; (2) Use of rental car, taxicab, or other special conveyance for which reimbursement is claimed
is to the Government's advantage; and (3) Long distance phone calls and supplies or equipment purchased are necessary and in the interest of
the Government. Note: To approve long distance phone calls, approving officer must have written authorization from Agency Head or his /her
designee (31 USC 1348).