Form 1012 PDF Details

When government employees or military personnel embark on travel for official duties, the SF 1012 form, known as the Travel Voucher, becomes a crucial document in the process of managing, submitting, and reimbursing travel expenses. This document, detailed with necessary sections to be filled out by the traveler, encompasses various types of official travel, be it for temporary duty or a permanent change of station. The form meticulously captures all facets of travel expenses, from transportation, lodging, and meal costs, to incidental expenses such as laundry and tips. Notably, it includes provisions for both travel advances received and the reconciliation of these advances with the actual expenses incurred, ensuring transparency and accountability. The SF 1012 form also caters to the submission of dependent travel expenses, should the travel authorization cover immediate family members. With its comprehensive structure, the form insists on accuracy and honesty, warning of legal repercussions for falsification. Designed with a clear intent to streamline the reimbursement process, it emphasizes the detailed recording of expenses, backed by receipts and approval signatures, thereby facilitating a smooth pathway for government employees to claim their travel expenses. Additionally, its adherence to privacy and disclosure regulations reflects the meticulous effort to protect the personal information of the traveler, underscoring the form's role as a vital tool in the administrative framework of government travel.

QuestionAnswer
Form Name Sf 1012 Form
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names sf1012, porintable 1012 pasrr form, printable fillable tables, 1012 form

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TRAVEL VOUCHER

1.

DEPARTMENT OR ESTABLISHMENT,

2. TYPE OF TRAVEL

 

(Read the Privacy Act

 

BUREAU, DIVISION, OR OFFICE

 

 

 

 

 

 

TEMPORARY DUTY

 

 

Statement on the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

back)

 

 

 

 

 

PERMANENT CHANGE

 

 

 

 

 

 

 

 

 

OF STATION

 

 

a. NAME (Last, first, middle initial)

 

 

 

b. SOCIAL SECURITY NUMBER

(PAYEE)

c. MAILING ADDRESS (Include ZIP Code)

d. OFFICE TELEPHONE NO.

 

 

TRAVELER5.

 

 

 

 

 

 

 

 

e. PRESENT DUTY STATION

 

 

f. RESIDENCE (city and State)

 

 

 

 

8. TRAVEL ADVANCE

 

 

 

 

 

 

 

 

 

9. CASH PAYMENT RECEIPT

 

 

 

 

 

 

 

 

 

a. Outstanding

 

 

 

 

a. DATE RECEIVED

b. AMOUNT RECEIVED

 

 

 

 

 

 

 

$

 

b. Amount to be applied

 

 

 

 

 

 

c. Amount due Government

 

 

 

 

c. PAYEE'S SIGNATURE

 

 

 

(Attached:

Check

Cash)

 

 

 

 

 

d. Balance outstanding

 

 

 

 

 

 

3.VOUCHER NO.

4.SCHEDULE NO.

6.PERIOD OF TRAVEL

a. FROM

 

b. TO

 

 

 

7. TRAVEL AUTHORIZATION

a. NUMBER(S)

 

b. DATE(S)

 

 

 

 

10.CHECK NO.

11.PAID BY

12.GOVERNMENT TRANSPORTATION REQUEST, OR TRANSPORTATION TICKETS, IF PUR- CHASED WITH CASH (List by number below and attached passenger coupon; if cash is used show claim on reverse side.)

 

 

 

 

 

 

 

 

 

 

 

I hereby assign to the United States any right I may have against any parties in connection with reimbursable

Traveler's Initials

 

 

 

 

transportation charges described below, purchased under cash payment procedures (FPMR 101-7).

 

 

 

 

 

 

 

 

 

 

 

 

AGENT'S

ISSUING

MODE,

DATE

 

POINTS OF TRAVEL

 

 

CLASS OF

 

 

 

VALUATION

CARRIER

 

 

 

SERVICE

ISSUED

 

 

 

 

 

 

OF TICKET

(Initials)

 

 

 

 

 

 

 

AND ACCOM-

 

FROM

 

 

 

TO

 

 

 

MODATIONS

 

 

 

 

 

(a)

(b)

(c)

(d)

(e)

 

 

 

(f)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.I certify that this voucher is true and correct to the best of my knowledge and belief, and that payment or credit has not been received by me. When applicable, per diem claimed is based and the average cost of lodging incurred during the period

covered by this voucher.

 

 

DATE

AMOUNT

 

 

 

TRAVELER

 

 

 

 

 

 

 

 

 

 

 

 

 

CLAIMED

$

 

SIGN HERE

 

 

 

 

 

 

NOTE; Falsification of an item in an expense account works a forfeiture of claim (27 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).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. This voucher is approved. Long distance telephone calls, if any, are certified as necessary

17. FOR FINANCE OFFICE USE ONLY

 

 

 

in the interest of the Government. (NOTE: If long distance telephone calls are included,

COMPUTATION

 

 

 

the approving official must have been authorized in writing by the head of the

a. DIFFER-

 

$

 

department or agency to so certify. (31 U.S.C. 680a).

 

 

 

 

ENCES,

 

 

 

 

 

 

 

 

 

 

 

 

 

APPROVING

 

DATE

IF ANY

 

 

 

 

 

 

 

 

 

 

 

 

(Explain

 

 

 

 

 

 

 

 

 

OFFICAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and show

 

 

 

 

SIGN HERE

 

 

 

 

 

 

 

 

amount)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. LAST PRECEDING VOUCHER PAID UNDER SAME TRAVEL AUTHORIZATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. VOUCHER NO.

b. D.O. SYMBOL

c. MONTH &

b. TOTAL VERIFIED CORRECT FOR

 

 

 

 

 

YEAR

CHARGE TO APPROPRIATION

 

 

 

 

 

 

Certifier's Initials:

 

$

 

 

 

 

 

 

 

 

16. THIS VOUCHER IS CERTIFIED CORRECT AND PROPER FOR PAYMENT

c. APPLIED TO TRAVEL ADVANCE

 

 

 

AUTHORIZED

 

 

(Appropriation symbol):

 

 

 

 

 

 

 

 

 

$

 

CERTIFIYING

 

DATE

 

 

 

 

 

OFFICAL

 

 

d. NET TO TRAVELER

 

 

 

SIGN HERE

 

 

$

 

 

 

 

 

 

 

 

18. ACCOUNT CLASIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NSN 7540-00-634-4180

 

 

 

 

STANDARD FROM 1012 (REV. 10-77)

 

 

 

 

 

 

 

Prescribed by GSA, FPMR (41 CFR) 101-7

 

 

 

 

 

INSTRUCTIONS TO TRAVELER (Unlisted items are self-explanation)

 

 

 

 

 

 

Complete this

PAGE

 

 

 

 

 

 

 

 

 

 

 

 

information

 

 

SCHEDULE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Col. (c)

If the voucher includes

 

Com-

 

Col. (d)

}

Show

amount incurred for each meal, including tax and tips, and

 

if this is a

of

 

 

OF

 

per diem allowances for

 

plete

 

(g)

daily total meal cost.

 

 

 

 

 

 

continuation

 

 

 

 

members of employee's

 

only

 

(h)

 

Show expenses, such as: laundry, cleaning and pressing clothes, tips

 

sheet

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXPENSES

 

immediate family, show

 

 

 

 

 

to bellboys, porters, etc. (other than for meals).

 

 

 

 

 

 

 

 

 

 

 

for

 

(i)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete for per diem and actual expense travel.

 

 

 

 

 

 

 

 

 

 

AND

 

 

member's names, ages

 

 

 

 

 

 

 

TRAVEL AUTHORIZATION

 

 

 

actual

 

(j)

 

Show total subsistence expense incurred for actual expense travel.

 

 

 

and relationship to em-

 

 

 

 

NO.

 

 

 

 

 

AMOUNTS

 

ployee and marital

 

expense

 

(m)

 

Show per diem amount, limited to maximum rate, or if travel on actual

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

expense, show the lesser of the amount from col. (j) or maximum rate.

 

 

 

 

 

 

 

CLAIMED

 

status of children

 

travel

 

(n)

 

Show expenses, such as: taxi/limousine fares, air fare (if purchased

 

 

 

 

 

 

 

 

 

 

 

 

TRAVELER'S LAST NAME

 

(unless information is

 

 

 

 

 

 

 

 

 

 

 

 

 

with cash), local or long distance telephone calls for Government

 

 

 

 

 

 

shown on the travel

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

business, car rental, relocation other than subsistence, etc.

 

 

 

 

 

 

 

 

 

 

 

 

authorization.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

TIME

 

DESCRIPTION

 

 

 

 

ITEMIZED SUBSISTENCE EXPENSES

 

MILEAGE

 

AMOUNT CLAIMED

 

 

 

 

 

(Hour

(Departure/arrival city, per diem

 

 

MEALS

 

 

MISCEL-

 

 

TOTAL

RATE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

computation, or other

 

 

 

 

 

LODGING

SUBSISTENCE

 

 

 

 

 

 

 

 

 

 

 

 

 

and

 

 

 

 

 

 

 

 

 

LANEOUS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

am/pm)

 

explanations

BREAK-

 

 

 

 

 

 

 

SUBSIS-

 

 

EXPENSE

NO. OF

MILEAGE

SUBSISTENCE

OTHER

 

 

 

 

 

of expense )

FAST

 

LUNCH

 

DINNER

 

 

TOTAL

TENCE

 

 

 

MILES

 

 

 

 

 

 

 

 

(a)

(b)

 

(c)

(d)

 

(e)

 

 

(f)

 

 

(g)

(h)

 

(i)

(j)

( k)

(l)

 

(m)

(n)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If additional space is required, continue on another SF 1012-A BACK, leaving the front blank.

 

 

 

 

 

SUBTOTALS ►

 

 

 

 

 

 

TOTALS ►

 

 

 

 

 

 

 

 

 

 

 

 

In compliance with the Privacy Act of 1974, the following information is provided: Solicitation of the information on this

investigations or prosecutions, or when pursuant to a requirement by this agency in connection with the hiring or firing of

Enter grand total of columns (l), (m) and

form is authorized by 5 U.S.C. Chap. 57 as implemented

by the Federal Travel Regulations (FPMR 101-7), E.O.

an employee, the issuance of a security clearance, or investigations of the per- formance of official duty while in

(n), below and in item 13 on the front of

11609 of July 22, 1971, E.O. 110012 of March 27, 1962,

E.O. 9397

of November 22, 1943, and 26 U.S.C. 6011(b)

Government service. Your Social Security Account

Number

(SSN) is solicited

under the authority of the Internal

this form.

and 6109. The primary purpose of the requested information is to

determine payment or reimbursement to eligible

Revenue Code (26 U.S.C. 6011 (b) and

6109)

and E.O.

9397, November

22, 1943, for use as a taxpayer and/or

 

 

individuals for allowable travel and/or relocation expenses incurred under appropriate administrative authorization and

employee identification number; disclosure

is

MANDATORY

on vouchers claiming travel and/or relocation allowance

TOTAL

to record and maintain costs of such reimbursements

to the Government. The information will be used by officers

expense reimbursement which is, or may

be,

taxable income. Disclosure of your SSN and other requested information is

AMOUNT

and employees who have a need for information in

the performance of their official duties. The information may be

voluntary in all other instances; however, failure to provide the

information (other than SSN) required to support the claim

CLAIMED ►

disclosed to appropriate Federal, State, local, or foreign agencies

when relevant to civil, criminal or regulatory

may result in delay or loss of reimbursement.

 

 

 

 

 

STANDARD FORM 1012 BACK (10-77)

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In an effort to finalize this PDF form, make sure you provide the necessary information in each blank:

1. While completing the optional form 1012, be certain to incorporate all of the necessary fields within the relevant part. This will help to expedite the work, enabling your information to be processed without delay and appropriately.

1012 form conclusion process shown (part 1)

2. After filling out the previous section, head on to the next part and enter the necessary particulars in these blank fields - I certify that this voucher is, DATE, TRAVELER SIGN HERE, AMOUNT CLAIMED, NOTE Falsification of an item in, This voucher is approved Long, APPROVING OFFICAL SIGN HERE, DATE, FOR FINANCE OFFICE USE ONLY, COMPUTATION, a DIFFER ENCES IF ANY Explain and, LAST PRECEDING VOUCHER PAID UNDER, b DO SYMBOL, c MONTH YEAR, and b TOTAL VERIFIED CORRECT FOR.

1012 form writing process clarified (step 2)

3. Within this part, look at THIS VOUCHER IS CERTIFIED CORRECT, AUTHORIZED CERTIFIYING OFFICAL, Certifiers Initials, c APPLIED TO TRAVEL ADVANCE, DATE, d NET TO TRAVELER, NSN, and STANDARD FROM REV Prescribed by. Every one of these must be completed with highest attention to detail.

STANDARD FROM REV Prescribed by, THIS VOUCHER IS CERTIFIED CORRECT, and c APPLIED TO TRAVEL ADVANCE inside 1012 form

4. This next section requires some additional information. Ensure you complete all the necessary fields - SCHEDULE OF EXPENSES AND AMOUNTS, DATE, TIME, Hour and, ampm, INSTRUCTIONS TO TRAVELER Unlisted, Com plete only for actual expense, i j m n, Col d, Show amount incurred for each meal, Complete this information if this, PAGE, TRAVEL AUTHORIZATION NO, TRAVELERS LAST NAME, and DESCRIPTION - to proceed further in your process!

Ways to complete 1012 form portion 4

Be very attentive when filling in DESCRIPTION and TRAVEL AUTHORIZATION NO, as this is the section in which most users make errors.

5. This document needs to be finalized by filling out this segment. Further you'll find a detailed list of blanks that must be completed with appropriate information for your document submission to be complete: If additional space is required, In compliance with the Privacy Act, investigations or prosecutions, SUBTOTALS TOTALS, Enter grand total of columns l m, TOTAL AMOUNT CLAIMED, and STANDARD FORM BACK.

Part number 5 for submitting 1012 form

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