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| Category: | | Travel | |
| Title: | | Request/Agreement for Moving Expense Reimbursement - State |
| Type: | | For State Employees | |
| Format: | | Adobe Acrobat (PDF)1 | | Microsoft Word/Excel | |
| Form: | |  | | | |
| Size: | | 95 KBytes | | Not Available | |
| Form Date: | | 08/04 | | | |
Related Link:
Special Notes:
Instructions and Examples:
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INSTRUCTIONS FOR PROCESSING OF REIMBURSEMENT REQUEST
1. The appointing officer must complete items 1-10 and the certification block.
2. The employee/appointee must sign the agreement satisfying the provisions as set forth in Section 202, subdivision 3 and Section 204, subdivision 2 of the State Finance Law.
3. If appointee, attach copy of letter from Civil Service stating there is a shortage of qualified positions in the particular title.
Non-statutory positions must have the approval from the head of the department or agency.
4. Attach a bill of lading or freight bill issued by the carrier showing the charges collected, and copies of the three estimates including the receipted bill in the event a certified carrier is not used. Attach a copy of rental truck agreement, if applicable.
5. Summarize the detail of the allowable expenditures on a Standard Voucher (AC92) following the guidelines enumerated in the Division of the Budget’s Policy and Reporting Manual Item G-200 for Management/Confidential employees and G-205 for others who negotiate pursuant to Article 14 of Civil Service Law.
6. Submit the Standard Voucher (AC92), with all applicable documents attached, including form AC1099, on a separate Batch Transmittal (AC2387) marked batch type VMA. For Federal Income purposes a ‘W’ must appear in the IRS/Code block.
7. Please type or print plainly all entries on front of this form. |
Revision History:
08/04 - Form creation |