DS 189 Form PDF Details

In the realm of administrative procedures for travelers funded by the government, the DS-189 form stands as a pivotal document that meticulously outlines the process for obtaining travel reimbursements. This comprehensive voucher must be filled out by the recipients of such funds, commonly referred to as the payees, to accurately report expenses incurred during their official travels. The form serves multiple functions, including the verification of the payee's complete name and address, travel authorization details, social security number for identity and processing purposes, and the detailed accounting of travel advances and their status. Additionally, it mandates the documentation of government-furnished transportation, if utilized, and includes a certification by the payee to attest to the accuracy and receipt of the claimed expenses. The administrative approval section is crucial for the validation of the reimbursement claim, further instilling a layer of oversight. Moreover, the form necessitates a historical account of previous payments for similar authorizations, ensuring transparency and accountability in the use of government funds. The method of payment section specifies the mechanics of fund disbursement, emphasizing the form's role in facilitating efficient financial transactions. Furthermore, it addresses compliance with legal stipulations against fraudulent claims, underscoring the serious implications of misreporting. Including an itinerary and transportation expenses, the form requires detailed documentation, supported by receipts and relevant remarks, to foster a thorough review and approval process. The DS-189 form, backed by Privacy Act statements and legal authority, exemplifies a structured approach to managing government travel reimbursements, reflecting a commitment to accuracy, integrity, and accountability in public service financial transactions.

QuestionAnswer
Form Name DS 189 Form
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names travel voucher vou, d s vou download, ds189, ds 189 pdf

Form Preview Example

* Items indicated by

1.

 

 

 

 

 

 

 

2. D.O. VOUCHER NO.

a Star are to be

 

 

 

 

 

 

 

 

Completed by the

 

 

 

(AGENCY)

 

 

 

 

Payee.

 

 

 

U.S. Department of State

 

 

 

 

 

 

 

 

 

 

3. BU. VOU. NO.

 

 

 

TRAVEL REIMBURSEMENT VOUCHER

 

 

 

 

*4. PAYEE'S COMPLETE NAME AND ADDRESS

 

 

 

 

 

 

 

*5. TRAVEL AUTHORIZATION

 

 

6. D.O. PAID BY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Number

B. Dated (mm-dd-yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*7. SOCIAL SECURITY NUMBER

 

*8. TRAVEL ADVANCE STATUS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Old Balance

 

 

 

 

 

 

 

 

 

 

 

 

 

*9. OFFICIAL STATION

 

 

 

 

 

 

 

 

 

 

 

 

 

B. Applied This Voucher

 

 

(State Only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. New Balance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*10. STATEMENT OF GOVERNMENT-FURNISHED TRANSPORTATION

 

 

 

E. Point-to-Point Travel

 

 

 

 

 

 

 

 

 

 

A. GTR or Vou. No

B. Valuation

C. Carrier*

D. Class

(1) from

(2) to

*11. PAYEE CERTIFICATE: Certified Correct. Payment or credit has not been received.**

 

12. PAYMENT CALCULATION

 

 

 

 

 

 

 

 

 

A. Date (mm-dd-yyyy)

B. Signature

 

 

*A. Amount Claimed

 

 

 

 

 

 

(See Item 18.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. ADMINISTRATIVE APPROVAL:

 

 

B. Differences, if any

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Date (mm-dd-yyyy)

B. Signature (See Item 8B.)

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Amount Allowed

 

 

 

 

 

 

(Verified correct

 

 

 

Name:

 

 

 

 

 

 

 

to Appropriation

 

 

 

 

 

 

 

 

 

Title:

 

 

 

 

 

 

 

 

 

 

 

 

*14. PREVIOUS

PAYMENTS: The next previous Vou. paid under same travel auth. was:

 

 

 

 

 

 

 

 

A. D.O. Vou. No.

 

B. Paid (mm-yyyy)

C.D.O. Name and Symbol

 

D. Applied to Advance

 

 

 

 

 

 

(See Item 8B.)

 

15.CERTIFIED FOR PAYMENT: Pursuant to authority vested in me, I certify this voucher is correct and proper for payment:

A. Date (mm-dd-yyyy) B. Authorized Certifying Officer's Signature

E. Net to Payee

Name:

Title:

16.METHOD OF PAYMENT (For Paying Office Use Only)

A. Cash or Dep. Check Amt.

 

B. Exchange Rate

 

C. U.S. $ Equivalent

 

*D. Date (mm-dd-yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Treasury or Depository Check No. and Name of Depository

 

*F. Payment Received

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Payee's Signature)

 

 

17. ACCOUNTING CLASSIFICATION

D. Organization,

E. Function

F.

Object,

G.Paying Office

H. Paying Date

I.Amount

A.

Fund

B. Allotment

C. Oblig. (T/A) No.

Subcost, etc.

 

Resource, etc

 

(mm-dd-yyyy)

(State)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Item 10C - If carrier was foreign ship registry, attach certificate of readiness.

**FRAUDULENT CLAIM - Falsification of any item in an expense account works a forfeiture of the claim (28 U.S.C. 2514) and may result in a fine of not more than $10,000 or imprisonment for not more than 5 years or both (18 U.S.C. 287; i.d. 1001).

DS-189

Page 1 of 2

06-2003

 

*18. CLAIM (Show complete itinerary and/or transportation expenses for persons and things for which reimbursement is claimed; on effects, show weights/measures and attach all receipts.)

REMARKS (Names of dependents including date of birth (DOB) of dependent children, explanation for use of foreign registry ship, rates of exchange, etc.)

Dates

(mm-dd-yyyy)

(A)

Local Time

(B)

Itinerary and Description

Per Diem

Days

(D)

Daily Rate

(E)

Amount

Per Diem

Other

(F)(G)

 

GRAND TOTAL TO ITEM 12A ON FACE OF VOUCHER

 

(Subtotals To Be Carried Forward)

PRIVACY ACT STATEMENT

Authority: E.O. 9397, dated November 22, 1943 and 5 U.S.C. 5705

Use of your social security number (SSN) is mandatory to process your application or claim. It is used in the mechanized travel advance data system, in addition to your name, as an identifier to assure crediting advances and reimbursements to the right person. Your providing your number will facilitate faster, more accurate processing. If you do not provide your SSN at this time, it must be researched manually with attendant delay, and with the possibility of errors if your claim is confused with that of another person having a similar name. Completed forms are subject to audit by the U.S. Department of State and General Accounting Office.

DS-189

Page 2 of 2

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It is actually simple to finish the form with this detailed guide! Here's what you have to do:

1. Before anything else, once completing the how to ds 189, begin with the form section that includes the subsequent fields:

Step no. 1 of completing i ds 189 form

2. Now that the last array of fields is finished, it is time to put in the needed specifics in PAYEE CERTIFICATE Certified, PAYMENT CALCULATION, A Date mmddyyyy, B Signature, ADMINISTRATIVE APPROVAL, A Date mmddyyyy B Signature See, Name Title, PREVIOUS PAYMENTS The next, CDO Name and Symbol, B Paid mmyyyy, A Amount Claimed See Item, B Differences if any, C Amount Allowed Verified correct, D Applied to Advance See Item B, and CERTIFIED FOR PAYMENT Pursuant to so that you can go further.

i ds 189 form completion process shown (portion 2)

3. This next step should also be relatively easy, A Cash or Dep Check Amt, B Exchange Rate, C US Equivalent, D Date mmddyyyy, E Treasury or Depository Check No, F Payment Received, ACCOUNTING CLASSIFICATION A Fund, B Allotment C Oblig TA No, D Organization Subcost etc, E Function F Object, Resource etc, Payees Signature, GPaying Office H Paying Date, mmddyyyy, and IAmount State - each one of these form fields must be filled in here.

F Payment Received, E Treasury or Depository Check No, and Payees Signature in i ds 189 form

4. This next section requires some additional information. Ensure you complete all the necessary fields - REMARKS Names of dependents, exchange etc, Dates, mmddyyyy, Local Time, Itinerary and Description, Per Diem, Days, Daily Rate, Amount, Per Diem, and Other - to proceed further in your process!

Writing segment 4 of i ds 189 form

5. The document has to be completed by dealing with this part. Further there's a comprehensive listing of blank fields that require correct details in order for your form usage to be faultless: GRAND TOTAL TO ITEM A ON FACE OF, Subtotals To Be Carried Forward, and PRIVACY ACT STATEMENT Authority EO.

Completing part 5 in i ds 189 form

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