ࡱ>  | @ Nbjbj <؝؝W0H,3 2228F&d' j}/ p#dddddd$R5y}"SF) V28 084 pS  St{ S{{{  9L9  LSTATE EMPLOYEE TRAVEL VOUCHERVoucher No.Michigan Department of Human ServicesType or Print Number of input characters are in parenthesesApprop. Yr.Page/OfInput Date/InitialsApproved Date/InitialsA) EMPLOYEE INFORMATIONEmployee NameMain-FACS Agency Number (5)Employee Soc. Sec. #Mail Code FORMTEXT      431 FORMTEXT       FORMTEXT       FORMTEXT      Home Address  StreetCityStateZip Code FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Official Work Station & BldgContact Person & Work Phone NumberPeriod Covered FORMTEXT       FORMTEXT      From: FORMTEXT      To: FORMTEXT      Travel AdvanceAdvance AmountAdvance Authorization Number FORMCHECKBOX No FORMCHECKBOX Yes FORMTEXT      431.ANature Of Official Business (Purpose/Description)/Comments: FORMTEXT      B) TRAVEL DETAILS FORMCHECKBOX I have documentation supporting that no state car was available to use.DateHours Of (Am/Pm)*Mileage$$ Meals AmountsTravel Description  Point To Point (Include State Vehicle No.)DepartReturnSTDPrem$ Amount**Lodging Room ChargeOver NightNo Over NightOther Expense AmountDaily Total  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar1+motel1+nontax1+tax1+oes1) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar2+motel2+nontax2+tax2+oes2) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar3+motel3+nontax3+tax3+oes3) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar4+motel4+nontax4+tax4+oes4) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar5+motel5+nontax5+tax5+oes5) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar6+motel6+nontax6+tax6+oes6) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar7+motel7+nontax7+tax7+oes7) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar8+motel8+nontax8+tax8+oes8) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar9+motel9+nontax9+tax9+oes9) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar10+motel10+nontax10+tax10+oes10) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar11+motel11+nontax11+tax11+oes11) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar12+motel12+nontax12+tax12+oes12) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar13+motel13+nontax13+tax13+oes13) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar14+motel14+nontax14+tax14+oes14) 0.00.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar15+motel15+nontax15+tax15+oes15) 0.00.0023. COLUMN TOTAL % FORMTEXT  =sum(ABOVE) 0.00.00 FORMTEXT  =sum(ABOVE) 0.00.00 FORMTEXT  =sum(ABOVE) 0.00.00 FORMTEXT  =sum(ABOVE) 0.00.00 FORMTEXT  =sum(ABOVE) 0.00.00 FORMTEXT  =SUM(ABOVE) 0.00.00 FORMTEXT  =SUM(ABOVE) 0.00.0024. 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Check only one box below. FORMCHECKBOX 1. Legal or Federal Mandate FORMCHECKBOX 2. Health & Safety FORMCHECKBOX 3. Budget Savings FORMCHECKBOX 4. Mission Critical Administrative TravelEmployee SignatureDateSupervisor SignatureDate FORMTEXT       FORMTEXT       Distribution: Original  Send to DHS Accounting OFFICE Retain copy for your files  INSTRUCTIONS: Improper or incomplete Travel Vouchers may be returned and require resubmission. It is especially important to assure the account coding structure is accurate and that the travel voucher is properly authorized. EFT/reimbursement will be sent to the payee s address on the MAIN vendor file. Travel related information is available at the following sites: MAIN vendor file registration and update:  HYPERLINK http://www.michigan.gov/budget www.michigan.gov/budget (under Financial Management/ Other OFM Services); State Travel Regulations:  HYPERLINK http://www.michigan.gov/dmb www.michigan.gov/dmb (under Agency Services/Travel); DHS Policy and Procedures: DHS Administrative Handbook, Section Series 800. a) EMPLOYEE INFORMATION INSTRUCTIONS: 1 Enter name; MAIN-FACS agency number (index code); employee social security number; Mail Code (if known) Enter home address. Enter official work station; contact person/preparer and work phone number; period covered (beginning date of first trip through ending date of last trip). Enter  X in the NO box if there was no advance, or  X in the YES box if travel advance was received for this travel period; enter advance amount; advance authorization number (if known). Enter nature of business travel for this period. B) Travel Details INSTRUCTIONS: 1. Date of travel. If Out of State Travel, attach an approved Request for Out of State Travel Authorization Form (DHS-1563. 2. Enter daily travel description point to point, such as departure and return to work location (i.e. local/district office). When travel is to a clients home, indicate nature of business requiring travel and specify departure and destination, including city of call. Client case number and last names are required when claiming youth meals. 3. Enter time of departure and return for each series of calls made each day to substantiate meal and lodging. For overnight trips, put departure time on the day you leave and return time on the day you return. Enter MILEAGE* for the use of privately owned cars on state business. Enter the number of map miles (point to point) traveled (MI Dept. of Transportation map or Rand McNally for out-of-state) rounding to the nearest whole mile. Vicinity mileage when incurred for state business purpose and in connection with the trip is allowable and must be shown as a separate item on the voucher. Multiply total miles by applicable reimbursement rate and enter in dollar amount column. If claiming PREMIUM MILEAGE, check the box that states  I have documentation supporting that no state car was available to use . You and your supervisor are responsible for maintaining written documentation supporting your representation that no state car was available. Copies of this documentation must be provided to Central Office upon request. *Refer to departmental guidelines or procedures for guidance in the use of the standard and premium mileage rates. 5. Enter the actual lodging cost. Receipts for lodging expenses are required. For reimbursement above state rate, and attach copy of the travel agency confirmation. 6. Enter total for meal(s) per day. 7. Itemize and identify amounts for other business expenses incurred. Receipts for registration, bus fare, and parking expenses (except meter parking), etc., are required by the Standardized Travel Regulations. (Meter parking costs should be identified by entering MP). 8. Enter the total per day. 9. Enter the summary totals, by column. C) Coding ENTRY Instructions: 1. Enter proper/appropriate Appropriation Year, Index code and PCA code, and amount (or percent of expenditure). Note: Agency object codes will be entered by the business office personnel. 2. Enter amount in TOTAL box (must equal amount entered in Summary Total box for Daily Total column). If percentage is used, must equal 100%. D) Signatures: 1. Employee must sign and date - ORIGINAL SIGNATURE IS REQUIRED. 2. Original signature of the individual authorizing payment and date signed are required. Signature stamps are not acceptable. Print or type the individual s name below the signature. 3. When signing the travel voucher, you are verifying that you have written documentation supporting no state available when claiming premium mileage and the travel was pre approved and necessary to accomplish the DHS mission according to the executive directive criteria. You must check only one of the four categories certifying that costs have been incurred in accordance with Executive Directive 2007-19 Travel Moratorium.AUTHORITY: 42 CFR; and Public Act 280 of 1939, as amended. RESPONSE: Voluntary. PENALTY: NoneDepartment of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area. DHS-1582-TV (Rev. 8-08) Previous edition obsolete. 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