1. Department - Enter the name of the agency (DHS), and the division or office for which the claim is submitted.
2. Payee - Enter the name of the traveler or person to be reimbursed. The social security number is to be entered to the right of the name.
3. Address - Enter the address of the traveler.
4. Official Station - Enter the agency assigned official station for the traveler.
5. License Number - Enter the license number of the private vehicle used if the traveler is the owner and mileage is being claimed.
6. Date - Enter the dates of the travel.
7. Town - List the towns where expenses were incurred.
8. Expenses - Enter the amount to be reimbursed for each item listed. All amounts entered in the “incidentals” column must be indicated by number. If number 8 was entered, explain fully.
9. Total - Enter the total for each day.
10. Travel between Cities/Towns:
a. From and To - Enter the cities/towns travel began and concluded.
b. Mileage - Enter the city limit to city limit map mileage between the points listed.
11. Vicinity Mileage:
a. From and To - Enter the name of the city/town where vicinity miles are traveled.
b. Mileage - Enter the number of miles traveled on official business after arrival at a destination. If the mileage is over twenty-five miles, a brief explanation must be included. (E.g., street name, route number, number of trips.)
12. Rate - Enter the rate of twenty-eight cents per mile.
13. Amount - Enter the product of item 11 times item 12.
14. Subtotals - Enter the total of the “detailed expenditures.”
15. Total for Mileage - Enter the total of the mileage columns.
16. Subtotal - Enter the total of the “detailed expenditures.”
17. Mileage Claimed - Enter the total claimed for mileage.
18. Total Claimed - Enter the total reimbursement claimed.
19. Travel Supervisor - The travel supervisor must sign the copy with the total amounts.
20. Signature of Traveler - The traveler must sign the copy with the total amounts.
21. Title - Enter the traveler's position title.
Note: The submitted Form TR-1 must comprise at least an original and one copy. Official business (character 02), and training (character 09) should not be included on the same Form TR-1. Because the fiscal year ends on June 30, anything after that date must be submitted on a separate Form TR-1.
Instructions for Travel Expense Reconciliation Form (DHS-1012)
A. Traveler - Enter employee's name and social security number.
B. Official Station - Enter the town/city where traveler is located.
C. Purpose of Travel - Enter the name of the activity attended.
D. Date - Fill in dates for each day there is a direct bill charge or a Form TR-1 charge.
E. Name of Town Visited - City visited must be written for each date. DO NOT use ditto marks.
F. Meals - Enter meal charges claimed on Form TR-1. Combine all daily charges into one total. Do not list charges separately. The total of the Form TR-1 meal costs plus the total of the direct bill meal costs cannot exceed the daily limit.
G. Total - Re-enter the meal charges claimed on the Form TR-1. No other costs (taxi, mileage, parking, etc.) are listed on Form DHS-1012.
H. Meals Amount - Enter meal charges direct billed at the hotel. Again, this should be one daily total.
I. D or C - D should be entered in each space where there is a direct bill charge; C for credit card charge.
J. Lodging Amount - Enter Room costs with tax. Charges should be listed only when there is a cost incurred. (There should not be a room cost for the last day of training.)
K. Total Amount - Enter the total amount of direct billed charges (direct billed meals plus lodging amount). Form TR-1 meal charges should not be included in this amount.
L. Total Daily Expenses - Enter the total of all daily charges (Form TR-1 meal charges plus direct billed total amount).
M. Total TR-1 Claim - Total column G. This total should be exactly the same as the amount claimed on the Form TR-1 for meals.
N. Total Expenses - Total column L. This will be the grand total for the entire training session.
O. Signature of Traveler - Employee must sign Form DHS-1012 before Administrative Services will process Form TR-1 for payment.
P. Position of Traveler - Enter the employee's position title.
Q. Travel Supervisor or Administrator - Signature of travel supervisor or administrator.
REQUEST FOR WAIVER OF MAXIMUM PER DIEM
TO: Administrator, Department of Finance and Administration (DFA) - Office of Accounting
FROM:
Director, Division of
DATE: __________
Waiver to be granted to __________, who will be attending __________, in __________, on __________.
Attached are Travel Authorizations (DHS-1010) for the above named employee. This is a request that he/she be allowed to exceed the per diem allowed by the State by approximately $ __________ per day. The request for waiver is being made for the following reason(s):
APPROVED:
DATE:
Division Director
APPROVED:
DATE:
Administrator, DFA Office of Accounting or Authorized Representative
NOTE: The Form DHS-1010 is required for Out-of-State Travel only.
Instructions for completing the Application for Out-of-State Travel (DHS-1010):
The traveler will complete the Application for Out-of-State Travel (DHS-1010) in triplicate and forward it to the division director for approval, allowing for required intermediate approvals, management review, and the utilization of the most economical travel mode and rates. Exceptions can be made for emergency travel.
DHS-1010 must be supported by justification for the trip and a document, e.g., a letter of invitation or conference agenda, which describes the event. Approval authority may not be delegated below the division director level to anyone other than an Acting/Interim Division Director. DHS Director is the approval authority for all divisions' out-of-state travel requests. DHS-1010 will be forwarded to DHS Director at least ten working days before the travel date.
Instructions for completing DAS Voucher Coding Sheet:
GENERAL INFORMATION: Each invoice must be put on a separate coding sheet; however, invoices to the same vendor will automatically combine into one payment, unless otherwise noted.
1. Coded by - Name or initials of person completing the code sheet.
Date - Date code sheet is completed.
2. Keyed by - Name or initials of person keying the coding information into the accounting system for payment.
Date - Date code sheet is completed.
3. Invoice Number - The number assigned by the vendor invoice.
4. Vendor Number or Vendor Name - If known, enter the vendor number which is the employer identification number or social security number, or the full, correct vendor name.
5. Y Vouch? - If an old year voucher, place a Y here.
Contract/MOF - The contract number or MOF number.
Gross Amount - The total amount of all expense lines plus tax, freight and additional costs, but without discount.
6. Sep Pymt? - If a separate check is required for this payment, place a Y here.
Remit Msg - Invoice date, invoice number, purchase order number, and other pertinent information.
7. These items will automatically be prorated to each of the expense lines listed on the coding sheet:
Sales Tax - The tax from the invoice, if applicable.
Freight - The freight from the invoice, if applicable.
Addl Cost - Any additional costs listed on the invoice, such as insurance, handling, etc.
Disc - The amount or percent of any discount offered (percent must have % sign).
8. Amount - The amount of each expense line.
Co - The activity.
Account - 5, the appropriation, character, allocation, and expenditure object code without spaces or punctuation.
Center - The section, unit, element and agency program code.
INVWKST2 AR - This field will be completed by DAS Payable staff from the listing of valid Accounting Rules.
INVWKST3 TT - The transaction type (A, B, C, or X).
PURCH - The purchase code (EL, ST, SO, etc.).
(Transaction type is an “A”, and Purchase code is “EL” for travel reimbursement requests.)
* These fields will be completed, if necessary, by Payable staff.
** Remit msg field should contain the beginning and ending dates of travel. (Ex. 09/01-10/15/93)
1. Department - Enter the name of the agency (DHS), and the division or office for which the claim is submitted.
2. Payee - Enter the name of the traveler or person to be reimbursed. The social security number is to be entered to the right of the name.
3. Address - Enter the address of the traveler.
4. Official Station - Enter the agency assigned official station for the traveler.
5. License Number - Enter the license number of the private vehicle used if the traveler is the owner and mileage is being claimed.
6. Date - Enter the dates of the travel.
7. Town - List the towns where expenses were incurred.
8. Expenses - Enter the amount to be reimbursed for each item listed. All amounts entered in the “incidentals” column must be indicated by number. If number 8 was entered, explain fully.
9. Total - Enter the total for each day.
10. Travel between Cities/Towns:
a. From and To - Enter the cities/towns travel began and concluded.
b. Mileage - Enter the city limit to city limit map mileage between the points listed.
11. Vicinity Mileage:
a. From and To - Enter the name of the city/town where vicinity miles are traveled.
b. Mileage - Enter the number of miles traveled on official business after arrival at a destination. If the mileage is over twenty-five miles, a brief explanation must be included. (E.g., street name, route number, number of trips.)
12. Rate - Enter the rate of twenty-eight cents per mile.
13. Amount - Enter the product of item 11 times item 12.
14. Subtotals - Enter the total of the “detailed expenditures.”
15. Total for Mileage - Enter the total of the mileage columns.
16. Subtotal - Enter the total of the “detailed expenditures.”
17. Mileage Claimed - Enter the total claimed for mileage.
18. Total Claimed - Enter the total reimbursement claimed.
19. Travel Supervisor - The travel supervisor must sign the copy with the total amounts.
20. Signature of Traveler - The traveler must sign the copy with the total amounts.
21. Title - Enter the traveler's position title.
Note: The submitted Form TR-1 must comprise at least an original and one copy. Official business (character 02), and training (character 09) should not be included on the same Form TR-1. Because the fiscal year ends on June 30, anything after that date must be submitted on a separate Form TR-1.
Credits
Eff. Nov. 15, 1994.
Current with amendments received through May 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.14.1-304 APPENDIX B, AR ADC 016.14.1-304 APPENDIX B
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