Optional Form 1164 at a glance
What it is: Optional Form 1164 is the claim for reimbursement for expenditures on official business.
Who signs: The CLAIMANT signs under SIGN HERE and enters the DATE.
A filled-in Optional Form 1164 example: a local trip with a toll and parking
How to fill out Optional Form 1164, box by box
Boxes 1 to 5, the office, the numbers, the name and paid by
Enter in box 1 the department or establishment, bureau, division or office.
Enter the voucher number in box 2.
Enter the schedule number in box 3.
Under box 4, enter the name (last, first, middle initial) in a.
Enter the employee ID number in b.
Disclosure of your ID Number is MANDATORY on vouchers claiming payment or reimbursement which is, or may be, taxable income, and voluntary in all other instances.
Enter the mailing address in c, and include the ZIP Code.
Enter the office telephone number in d.
Box 5 is PAID BY. Read the Privacy Act Statement on the back of this form.
Box 6, the expenditures
Show the appropriate code in column (b): A - Local Travel, B - Telephone or Telegraph, C - Other expenses (itemized), D. Funeral Honors Detail or E. Specialty Care.
Enter the DATE in (a) and the CODE in (b).
Explain expenditures in specific detail in (c) FROM and (d) TO.
Enter whole numbers only in the MILEAGE RATE.
Enter NUMBER OF MILES (e), MILEAGE (f) and FARE OR TOLL (g).
If fare or toll claimed in column (g) exceeds charge for one person, show in column (h) the number of additional persons which accompanied the claimant.
Enter ADD PERSONS (h) and TIPS AND MISCELLANEOUS (i).
If additional space is required continue on the back.
On the back, total each column and enter on the front, subtotal line.
Box 7, the totals
Box 7, AMOUNT CLAIMED, is the total of columns (f), (g) and (i).
Boxes 8 to 12, approval, signatures and payment
In box 8, the APPROVING OFFICIAL signs under SIGN HERE: This claim is approved.
If long distance calls are included, the approving official must have been authorized in writing, by the head of the department or agency to so certify (31 U.S.C. 680a).
Long distance telephone calls, if shown, are certified as necessary in the interest of the Government.
In box 9, the AUTHORIZED CERTIFYING OFFICER signs under SIGN HERE: This claim is certified correct and proper for payment.
In box 10, by signing you certify that this claim is true and correct to the best of your knowledge and belief and that payment or credit has not been received by you.
Sign Original Only.
Box 11, CASH PAYMENT RECEIPT, has a. PAYEE (Signature), b. DATE RECEIVED and c. AMOUNT.
Box 12 is PAYMENT MADE BY CHECK NUMBER.
More rules for Optional Form 1164
Failure to provide the information (other than ID Number) required to support the claim may result in delay or loss of reimbursement.
Common questions about Optional Form 1164
What is form 1164?
Optional Form 1164 is the claim for reimbursement for expenditures on official business. The primary purpose of the requested information is to determine payment of reimbursements from the Government.
Sources
[1] Optional Form 1164 (REV. 11/2017), Claim for Reimbursement for Expenditures on Official Business (the Official source link on this page).