SPONSORED FUNDS
ADMINISTRATION
DIVISION OF RESEARCH
State University of New York at Binghamton
INSTRUCTIONS
TO RELOCATION EXPENSE
AUTHORIZATION AND PAYMENT FORM
How to Complete the Form
The Relocation Expense Authorization and Payment form must be completed according to the policy and
procedure described in "IRS Requirements for Reimbursement of Moving Expenses".
Complete the form as follows:
Amount
Enter total dollar amount of reimbursement.
Tax Classification Amount
Enter the dollar amount of each expense, in the
qualified or nonqualified column.
Payment To
Detail the amount paid to the employee or third
party.
Total
Enter the total for each column. Combined totals for
each column must equal the total amount
reimbursed
Documentation Required
The following table lists the type of documentation required for each type of qualified moving expense. Attach
the appropriate documentation to this form.
Qualified Expense
Documentation Required
Packing
Authorized certificate of packing
Moving
Canceled check or original receipt from
mover AND itemized invoice4
Shipping
Receipted bill of loading
Storage
Cancelled check or original receipt AND
itemized invoice
Mileage
Shortest highway route (IRS standards) at
current IRS reimbursement rate for moving
expenses.
Note: This rate should not be confused with
the corporate travel reimbursement rate for
mileage
Meals and Other Expenses
Original Receipts
PO Box 6000, Binghamton, NY, 13902-6000. Ph: (607) 777-6752. Revised
6/07/04
FORM
SFA - 6
SPONSORED FUNDS
ADMNIISTRATION
DIVISION OF RESEARCH
State University of New York at Binghamton
RELOCATION EXPENSE AUTHORIZATION AND PAYMENT
Name:
Social Security Number:
Address:
City: State:
Zip:
Assignment:
Effective Date of Appointment:
Relocation Date:
Tax Classification Amount
Payment To
Expense
Amount
Qualified
(nontaxable)
Nonqualified
(taxable)
Employee
Third Party
Packing
Moving
Storage
Mileage
Lodging
Meals
Other
Total*
*Attach required documentation for the type of expense(s) listed above (refer to "How to Complete the Form" instructions).
The maximum reimbursement is $3,000.
Certification of Receipt:
Signature of Appointee
Date
This is to certify that the expenses listed above were incurred in the relocation of personal/household items. I understand
that I am liable for any taxation resulting from reimbursement of nonqualified expenses. I understand that if I leave from
this position for reasons within my control within 12 months of the assignment start date, moving expenses must be repaid
to the Research Foundation of SUNY.
Certification of Project Director
Signature of Project Director
Date
This is to certify that the reimbursement of moving expenses was necessary to attract the candidate(s). I have reviewed
the terms and conditions of this award and have determined that sponsor guidelines allow the reimbursement of relocation
expenses in this instance.
Authorization of Payment/Reimbursement Waiver:
Signature of Operations Manager or delegate
Date
PO Box 6000, Binghamton, NY, 13902-6000. Ph: (607) 777-6752.
Fax: (607) 777-4354 FORM SFA-6
Revised
6/07/04