Form Ad 616R – Fill Out and Use This PDF

The AD 616R form, commonly referred to as the Travel Voucher (Relocation), is a comprehensive document used by employees of the federal government to claim relocation expenses. This form facilitates the reporting of various costs associated with moving due to reassignment or initial employment, covering everything from transportation and lodging to the sale and purchase of residences. If you're undergoing a government-directed relocation, accurately completing the AD 616R form is crucial for reimbursement of associated expenses. Click the button below to learn more about how to fill out the form correctly.

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Form Ad 616R PDF Details

The AD 616R form, known as the Travel Voucher (Relocation), serves an essential function in documenting and processing the travel expenses for individuals relocating for work within various agencies. It meticulously outlines the identification details including the traveler's name, social security number, and agency codes to ensure accurate tracking and accountability. It also covers a wide range of expense types, from lodging and transportation to the costs associated with moving household goods and temporary quarters. The form requires detailed information on the travel authorization number, dates of travel, and type of claim to streamline the reimbursement process. The AD 616R form goes further to include sections for real estate transactions related to the relocation, capturing both the sale of the former residence and the purchase of the new one. Special attention is given to comply with the Fire Safety Standards for approved accommodations and the detailed itinerary of the relocation journey. Moreover, it incorporates a certification section where the claimant and an approving officer must attest to the accuracy of the information provided and the adherence to pertinent regulations. The meticulous design of the AD 616R form underlines the government's effort to manage the financial aspects of employee relocations while ensuring compliance with federal travel regulations and policies.

Question	Answer
Form Name	Form Ad 616R
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	CFR, ad 616r form, AD-424, GSA

Form Preview Example

TRAVEL VOUCHER (Relocation)

SECTION A -- IDENTIFICATION

1. TRAVEL AUTHORIZATION NO.

2. SOCIAL SECURITY NO.

3. NAME (Last)

(First)

(Middle Initial)

4. AGENCY

CODE

5. AGENCY ORIGINATING OFFICE

6. TRAVELER ORIGINATING

7. DATES OF TRAVEL EXPENSES

8. TYPE CLAIM (Indicate one type only)

9. RECLAIM

NUMBER

OFFICE NUMBER

FROM

THRU

HH = Hsehunting

SR = Supp RIT

AMOUNT

INCLUDED

Month

Day

Year

Month

Day

Year

TS = Trans Stn

OT = Outside

RC = Relo Contr

Cont. U.S.

RI = RIT

Transfer

10. DATE REPORTED AT NEW

11. LEAVE TAKEN

12. OFFICIAL DUTY STATION CITY AND STATE

13. RESIDENT CITY AND STATE (If other than official station)

OFFICIAL DUTY STATION

Y = Yes N = No

Month

Day

Year

14. TOTAL NIGHTS LODGING

15. NUMBER OF NIGHTS IN APPROVED ACCOMMODATIONS PER THE FIRE SAFETY ACT STANDAR DS

SECTION B -- TRAVEL VOUCHER MAILING ADDRESS OPTIONS

SECTION D -- CLAIMS

16. SALARY ADDRESS

17. T&A CONTACT POINT

18. SPECIAL ADDRESS

19. TRAVEL EFT ACCOUNT

26. TOTAL SALES PRICE OF FORMER RESIDENCE

27. TOTAL PURCHASE PRICE OF NEW RESIDENCE

1. (35)

28. EXPENSES CLAIMED BY RELOCATION SERVICES

COMPANY (For Type Claim RC Only, Invoice Attached)

a. APPRAISED VALUE SALES FEE

2. (35)

b. AMENDED VALUE SALES FEE

c. CANCELLATION FEES

3. City (20)

State (2)

Zip Code (9)

EXPENSES CLAIMED BY EMPLOYEE

SECTION C -- TRANSPORTATION COSTS

29. OUTSIDE CONT. U.S. SUBSISTENCE (Type Claim OT Only)

20.

21.

22.

23. CAR RENTAL

24.

LOCATION

NO. OF

METHOD OF

VENDOR/

IDENTIFICATION

AMOUNT

PAYMENT

CARRIER

NUMBER

MILES

DAYS

AMOUNT

CITY

DAYS

If payment was made by traveler,

TOTALS

complete Section G on reverse.

TOTAL OUTSIDE CONT. U.S. SUBSISTENCE $

25. AIRLINE ACCOMMODATIONS

Non-contract (Insert Code)

REAL ESTATE (Paid by Employee)

AMOUNT

NFC USE

Excess fare (Check if applicable)

a. SALES EXPENSE (AD-424 Attached)

SECTION E -- ACCOUNTING CLASSIFICATION

b. PURCHASE EXPENSE (AD-424 Attached)

50. AUTHORIZATION ACCOUNTING (Check this block if accounting from travel

authorization is to be charged for the total voucher claim.)

c. LEASE TERMINATION EXPENSE

51. DISTRIBUTED ACCOUNTING (Check this block and distribute total claim from Section D to

31. PER DIEM

the applicable Accounting Classification line.)

No. of Days [

] LODGING & IE

PURPOSE CODE

ACCOUNTING CLASSIFICATION

PERCENTAGE

No. of Travelers [

] MEALS

32. MILEAGE

Rate [

¢]

Miles [

]

Rate [

¢]

Miles [

]

Rate [

¢]

Miles [

]

Rate [

¢]

Miles [

]

33. PARKING, TOLLS, ETC.

34. PLANE, BUS, TRAIN (Paid by Traveler)

35. UNACCOMPANIED BAGGAGE

36. LOCAL TRANSPORTATION

37. MISCELLANEOUS EXPENSES/

ALLOWANCE

38. CAR RENTAL

THESE PERCENTAGES MUST EQUAL 100%

39. SHIPMENT OF HOUSEHOLD GOODS

Total Weight

[

]

SECTION F -- CERTIFICATION

40. STORAGE OF HOUSEHOLD GOODS

1ST 30 DAYS

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.

1001).

Total Weight

[

]

OVER 30 DAYS

CLAIMANT'S RESPONSIBILITIES AND SIGNATURE. I hereby assign to the United States any rights I may have

No. Days

[

]

against other parties in connection with any reimbursable carrier transportation charges described herein. I have received no

41. TEMPORARY QUARTERS (AD-569

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

attached)

No. of Days

[

]

have been accounted for as required by FPMR 101-7 and other regulations. I have reviewed this voucher and certify it to be

correct.

No. Occupants

[

]

52. CLAIMANT'S SIGNATURE

53. DATE

54. FINAL VOUCHER

42. RELOCATION INCOME TAX

Month

Day

Year

INDICATOR

Y = Yes N = No

(AD-1000 Attached)

APPROVING OFFICER'S RESPONSIBILITIES AND SIGNATURE. In approving this voucher, I have determined that: (1)

43.

TOTAL CLAIM

Reimbursement is claimed for official travel only; (2) Use of rental car, taxicab, or other special conveyance for which reimbursement is claimed

(Block 29 thru 42)

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

44. TRAVEL ADVANCE AMOUNT

designee (31 USC 1348).

OUTSTANDING

55. APPROVING OFFICER'S SIGNATURE

56. SOCIAL SECURITY NO.

45. AMT. OF VOUCHER (Block 43) TO BE

APPLIED TO OUTSTANDING ADVANCE

(Block 44)

57. NAME AND TITLE (Last, First, Middle Initial) (Type or Print)

AGENCY

CODE

46. AMT. OF VOUCHER (Block 43) TO BE

APPLIED TO OUTSTANDING BILL FOR

COLLECTION

58. DATE APPROVED

59. PHONE (Area Code and No.)

Month Day Year

BILL NO.

60. CONTACT PERSON

61. PHONE (Area Code and No.)

47 ADDITIONAL ADVANCE AMOUNT

REPAID (Check or Money Order

Attached)

Upon completion and approval, submit original voucher to:

48 REMAINING ADVANCE BALANCE

(Block 43 minus Blocks 45 and 47)

U.S. Department of Agriculture

49.

NET TO TRAVELER

National Finance Center

(Block 43 minus Blocks 45 and 46)

P.O. Box 60000

AUDITED BY

TOTAL DIFFERENCE

New Orleans, LA 70160

FORM AD - 616R (USDA) (Rev. 11/96)

Exception to SF 1012 approved by GSA 11/20/96

SOCIAL SECURITY NO.

TRAVELER'S NAME

SECTION G -- SCHEDULE OF EXPENSES AND AMOUNTS CLAIMED

ITINERARY

TOTALS

FROM

DATE (Month/Day)

Transfer

these totals to

CITY

Section D on

STATE

Voucher Front.

TIME

If additional

DATE (Month/Day)

days are

CITY

required, use

continuation

COUNTY

sheet

STATE

TIME

PER DIEM

TOTAL NO. DAYS

NO. OF DAYS

LODGING & INCIDENTAL

TOTAL LODGING & IE

EXPENSES

(Receipt Required for Lodging)

TOTAL MEALS

MEALS

MILEAGE

TOTAL MILES

MILES

RATE PER MILE

TOTAL MILEAGE

MILEAGE AMOUNT

TOTAL PARKING

PARKING, TOLLS, ETC.

PLANE, BUS, TRAIN

TOTAL PLANE, BUS,

TRAIN

(Paid By Traveler)

UNACCOMPANIED

TOTAL UNACCOMPANIED

BAGGAGE

LOCAL

TOTAL LOCAL

TRANSPORTATION

NO. TRIPS

DAILY EXPENSE

MISCELLANEOUS

TOTAL

EXPENSES/

MISCELLANEOUS

ALLOWANCE

CAR RENTAL

TOTAL CAR RENTAL

(Paid by Traveler)

Receipt and Car Rental

Agreement Required

RENTAL EXPENSE

GASOLINE EXPENSE

SHIPMENT OF HOUSEHOLD GOODS PAID BY TRAVELER (Weight Certificate or Bill of Lading Required)

TOTAL WEIGHT OF

COMMUTED RATE

TOTAL

ADDITIONAL ALLOWANCES

TOTAL SHIPMENT AMOUNT

GOODS SHIPPED

STORAGE OF HOUSEHOLD GOODS

TEMPORARY STORAGE

NUMBER OF	TOTAL
DAYS	WEIGHT
CLAIMED	OF GOODS

ACTUAL CHARGES

COMMUTED RATE CHARGES

CLAIM LESSER AMOUNT AND DISTRIBUTE TO APPLICABLE PERIOD OF STORAGE

1ST 30 DAYS AMOUNT

OVER 30 DAYS AMOUNT

REMARKS

PRIVACY ACT NOTICE. The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). The information requested on this form is required under the provisions of 5 USC, Chapter 57 (as amended) and Executive Orders 11609 of July 22, 1971, and 11012 of March 27, 1962, for the purpose of recording travel expenses incurred by the employee and to claim other entitlements and allowances as prescribed in the Federal Travel Regulations (41 CFR 301-304). The information contained in this form will be used by Federal Agency officers and employees who have a need for such information in the performance of their duties. Information will be transferred to appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal, or regulatory investigations or prosecutions or pursuant to a requirement by GSA or such other agency in connection with the hiring or firing, or security clearance, or such other investigations of the performance of official duty in Government service. Failure to provide the information required will result in delay or suspension of the employee's claim for reimbursement.

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In order to fill out this form, ensure you provide the information you need in every blank field:

1. Fill out the USC with a selection of major fields. Note all of the important information and make sure not a single thing overlooked!

2. Soon after performing the previous step, go on to the next step and fill out all required details in these blanks - REAL ESTATE Paid by Employee, AMOUNT, NFC USE, a SALES EXPENSE AD Attached, b PURCHASE EXPENSE AD Attached, c LEASE TERMINATION EXPENSE, PER DIEM, No of Days No of Travelers, LODGING IE MEALS, MILEAGE, If payment was made by traveler, Excess fare Check if applicable, Noncontract Insert Code, SECTION E ACCOUNTING, and AUTHORIZATION ACCOUNTING Check.

entitlements conclusion process described (portion 2)

3. Completing CLAIMANTS RESPONSIBILITIES AND, No Days, TEMPORARY QUARTERS AD attached, No of Days, No Occupants, CLAIMANTS SIGNATURE, DATE Month Day, Year, FINAL VOUCHER INDICATOR, Y Yes, N No, RELOCATION INCOME TAX, AD Attached, APPROVING OFFICERS, and APPROVING OFFICERS SIGNATURE is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Best ways to complete entitlements part 3

4. Completing SOCIAL SECURITY NO, TRAVELERS NAME, SECTION G SCHEDULE OF EXPENSES, ITINERARY, FROM, DATE MonthDay, CITY, STATE, TIME, DATE MonthDay, CITY, COUNTY, STATE, TIME, and PER DIEM is key in this next section - make sure to take the time and fill in each and every blank area!

STATE, FROM, and STATE inside entitlements

5. To conclude your form, this last segment involves a couple of extra blanks. Completing RATE PER MILE, MILEAGE AMOUNT, PARKING TOLLS ETC, PLANE BUS TRAIN, Paid By Traveler, UNACCOMPANIED, BAGGAGE, LOCAL, TRANSPORTATION, NO TRIPS, DAILY EXPENSE, MISCELLANEOUS, EXPENSES ALLOWANCE CAR RENTAL Paid, Receipt and Car Rental Agreement, and RENTAL EXPENSE is going to conclude everything and you'll be done in a tick!

It is easy to make an error while completing the MILEAGE AMOUNT, for that reason make sure to look again before you decide to submit it.

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