DOT - RTAP TRAVEL AUTHORIZATION

RTAP TRAVEL AUTHORIZATION
North Dakota Department of Transporation, Local Government
SFN 53759 (03/15)
REQUEST FOR TRAVEL AUTHORIZATION FOR OUT-OF-STATE TRAVEL. Use a separate form for each individual for each trip. Documentation must be provided if airfare costs in excess of the basic least expensive unrestricted accommodations offered. NDDOT only reimburses for allowable costs based on 2 CFR Part 200.474. Send forms to the Transit Section for approval.
Person Traveling (Last Name)*
Person Traveling (First Name)*
Title*
Transit Agency Name*
Number of Meetings, Locations, and Days the Person has traveled this Fiscal Year (July 1- June 30)*
Destination(s) (City and State)*
Date to Depart From Home*

MonthDayYear
Date
Date to be at Destination*

MonthDayYear
Date
Date Event Begins*

MonthDayYear
Date
Date Event Ends*

MonthDayYear
Date
Date to Return Home*

MonthDayYear
Date
Does trip include vacation hours/days?*

YesNo
Reason for Trip (Agenda must be attached)*

Conference or MeetingSeminar, Workshop, or TrainingRoutine WorkOther
Trip Agenda*

Cancelof
Name of Meeting or Purpose of Trip (Do Not Abbreviate)*

0/500
Total number of persons attending requesting RTAP reimbursement.*
Method of Travel*

Personal VehicleProject Vehicle 21 cents per mileTrainOther (Explain in Remarks).67 cents per mile all eventsCommercial AirBus
ESTIMATED COST OF TRIP (To Nearest Dollar - Must attach documents for lodging, GSA Per Diem, Hotel Reservations & Registration)
Transportation
Meals
Lodging
Registration
TOTAL
Estimated Cost Attachments*

Cancelof
COSTS WILL BE PAID BY*

RTAPOther (Explain in Remarks)
Remarks*
Signature of Person Traveling*
Date*

MonthDayYear
Date
RTAP Director Signature
Date

MonthDayYear
Date
Should be Empty: