FORM
SFA-12
SPONSORED FUNDS ADMINISTRATION
DIVISION OF RESEARCH
State University of New York at Binghamton
TRAVEL PAYMENT REQUEST
Project Task
Award Expenditure
Type
Organization
P.O.Number
Encumbrance Date
Advance
Date
Expense
Date
Name (First, Middle Init., Last)
Department
Home Address
City
State
Zip code
Date
Date
Point of Departure
Time a.m.
p.m.
Point of Return
Time a.m.
p.m.
Destination and Purpose of Travel
Conference
Foreign Travel
Relationship to Program
R.F. Employee
Consultant
Lecturer
SUNY Employee
Other (Explain)
If required, sponsor has provided prior approval__________(Yes)
TRANSPORTATION (Common Carrier)
TRANSPORTATION (All Other)
$ _______________ X 100%
$ _______________ X 80%
= $ _______________
= $ _______________
METHOD I PER DIEM
No. of days ________ X Rate ________
$ _______________ X 80%
= $ _______________
METHOD II LODGING AND MEAL ALLOWANCES
No. of days ________ , Lodging $ ________ , Meals $ ________
$ _______________ X 80%
= $ _______________
ENCUMBRA
NCE / A
D
VA
NCE
TOTAL ENCUMBRANCE
$ _______________
TOTAL ADVANCE (1) $ ________________
Traveler Signature
Date
Project Director Signature
Date
Operations Manager Signature
Date
TRANSPORTATION OTHER
EXPENSES
Departure Date
Return Date
Time
a.m. p.m.
Time
a.m. p.m.
A
C
TUA
L
EXPENSES
Common Carrier $_________
Parking $_________
Car Rental $_________
(justification required)
Personal Car
Miles_____ X Rate_______ $_________
Tolls $_________
Taxi $_________
Miscellaneous(Explain) $_________
Other $
TOTAL (2)
$_________
METHOD I PER DIEM
No. of Days Rate
_________ X __________ = $___________
MEAL ADJUSTMENT
Breakfast $_______________
Dinner $_______________
Total (3) $_______________
METHOD II LODGING AND MEALS
Number of Days $_______________
Lodging $_______________
Meal Allowance (3) $_______________
MEAL ADJUSTMENT
Breakfast $_______________
Dinner $_______________
Total (3) $_______________
I hereby certify that the above trip was taken for the
purpose indicated; that the above accounting is
accurate; that no portion has been paid, except as
stated on this form and that the balance indicated is
due or reimbursable in accordance with Research
Foundation Travel Policy.
Transportation Expenses (2)$ ___________
Per Diem/Meals and Lodging (3)$ ___________
Total Expenses $ ___________
Less Advance (P.O. No. ____________) (1)$ ___________
Balance Due Traveler $________
Balance Due Research Foundation
(attach check)$
________
Traveler Signature
Date
Project Director Signature
Date
Operations Manager Signature
Date
PO Box 6000, Binghamton, NY, 13902-6000. Ph: (607) 777-6752.
Fax: (607) 777-4354. FORM SFA-12
Revised
6/07/04