VA Form 0893 at a glance
What it is: VA Form OCT 2009 0893 is the Advance Review of Offer to Donate Support for Official Travel.
Where and when to file: NOTE: This VA Form 0893 is to be used to accept a gift of travel under 31 U.S.C. §1353 or 5 U.S.C. §4111 and does NOT replace travel authorization documents. Use this form in conjunction with the current VA travel management system. INSTRUCTIONS: Please complete and have office head sign on page 2. Forward to Assistant General Counsel (023)(VACO) or Regional Counsel (Field). They will review and return form to you. You must then provide form to one of the officials with gift acceptance authority listed on the bottom of page 2. Upon completion of your travel, this form (with all necessary signatures) must be included with your claim for reimbursement of travel expenses (travel voucher). Faxing a copy of this form to the current VA travel management system is acceptable.
A filled-in VA Form 0893 example: a speaker asks to accept paid travel
How to fill out VA Form 0893, box by box
Information about the VA employee (Traveler)
Under INFORMATION ABOUT VA EMPLOYEE (Traveler), fill in NAME OF VA EMPLOYEE, POSITION TITLE, DEPARTMENT/OFFICE and DUTY STATION.
Information about the donor and/or host organization
Under Information about donor and/or host organization, fill in Name of organization hosting the event and Name of donor organization (if different from host).
For the host and for the donor organization, fill in the point of contact (POC), the point of contact e-mail address and the point of contact daytime phone number, and the ext.
Information about the meeting or event
Under INFORMATION ABOUT MEETING OR EVENT SPONSORED BY (DONOR) HOST ORGANIZATION, fill in NAME AND ADDRESS OF EVENT, DATE OF EVENT and TIME OF EVENT.
In PURPOSE OF EVENT, include 1, how this event will further VA's interests, and 2, how this event relates to your official duties.
Fill in OTHER ENTITIES ATTENDING OR PARTICIPATING and ROLE OF EMPLOYEE-TRAVELER (e.g. attendee, speaker, trainer, etc.).
Did the donor offer to pay costs for other attendees similarly situated
YES or NO: did donor offer to pay costs for other attendees similarly situated (e.g. if you are going to be a speaker, did donor offer similar travel gifts to all speakers at the event?)
Gift codes, amounts and totals by category
Fill out dollar amount and appropriate Gift Code for each applicable category: lodging, meals, travel fares, ground transportation, event fees and other expenses. Include amounts for spouse if donor has offered to support spouse travel.
For LODGING, fill in NO. OF NIGHTS and COST PER NIGHT.
For TRAVEL FARES, mark COACH, PREMIUM or 1st CLASS, for SELF and for SPOUSE.
Fill in total lodging, total meals, total fares, total ground transportation, total fees, total other expenses and the grand total.
GIFT CODE KEY: 1 - In-Kind - e.g. donor provides airline ticket; 2 - Check/other monetary instrument payable to VA; 3 - Check/other monetary instrument payable to employee*; 4 - Cash to employee*. *VA employees receiving cash or check payable to employee must confirm that donor is a tax-exempt 501(c)(3) corporation.
Pending matters involving VA and the donor
To your knowledge, are there any pending contracts, proposals, requests for proposals, affiliation agreements, or other decisions or matters involving VA and donor? If YES, describe the pending matter in the REMARKS section.
Does VA employee have a role in VA action on any of the pending matters? If YES, describe the VA Employee's role in the REMARKS section.
Cash or check payable to employee, and REMARKS
If reimbursement will be by cash or check payable to employee, answer the following: 1. Is the donor a tax-exempt 501(c)(3) corporation? NO or YES. 2. Did you render service to the 501(c)(3) donor prior to this travel? NO or YES. If yes, provide details in REMARKS.
Certifications, review and approval signatures
The employee (Traveler) signs under SIGNATURE OF EMPLOYEE (Traveler) and fills in DATE SIGNED. By signing, you certify that the answers are truthful and correct, and that if you directly receive a cash or check payment from the donor, you will use these funds only for the listed travel expenses and you will refund any unused portion of these funds to the donor.
For the CERTIFICATION OF HEAD OF EMPLOYEE-TRAVELER'S OFFICE, the requesting office head or next higher official if requesting head is traveler signs (Print name and title) and fills in DATE SIGNED. By signing, the office head certifies that the travel relates to the employee's official duties and believes that the travel is in the interest of the Government.
Under GENERAL COUNSEL REVIEW, the Assistant General Counsel (023) or Regional Counsel or other Deputy Ethics Official signs and fills in DATE SIGNED. REVIEW FINDINGS: VA could lawfully determine that accepting the offered travel support would be proper.
Under ACCEPTANCE OF GIFT BY AUTHORIZED OFFICIAL, the approving official signs under SIGNATURE OF APPROVING OFFICIAL (Print name and title) and fills in DATE SIGNED. By signing you approve acceptance of the gift of travel support.
The officials authorized to make the determination: Secretary; Deputy Secretary, VA COS, VA Deputy COS, Under Secretary, Deputy Under Secretary, Assistant Deputy Under Secretary, Executive Assistant to the Under Secretary, Assistant Secretary, Deputy Assistant Secretary, Key Central Office Official and Deputy; VISN Director and Deputy Director, VBA Area Director and Deputy Director, Regional Counsel, NCA Memorial Service Network Director and Deputy Director, Field Facility Director and their Associate and Assistant Directors (and Medical Center COS if authorized by Medical Center Director).
Sources
[1] VA Form 0893 (OCT 2009), Advance Review of Offer to Donate Support for Official Travel, Department of Veterans Affairs (the Official source link on this page).