Stephen F. Austin State University

Moving Expenses Payment/Reimbursement Form

 

Employee Name: CID:

Moving Expenses may only be paid from Non-Appropriated Funds (fund numbers of 150000 or higher). See SFA Policy 3.23 (Moving Expenses) for more details. In accordance with IRS regulations, if mileage is an approved expenditure, the mileage reimbursement will be at the published IRS rate in effect for moving expenses on the date of the move unless a lower rate is negotiated by the department. (Reference IRS Publication 521, Moving Expenses, at http://www.irs.gov/ for the mileage rate and explanation of federal tax laws.)

Source of Funding:

Fund        Org        Program    Amount
       
       
       

I request that my moving expenses be paid/reimbursed in the following manner (select one):

1. Pay vendor directly. The invoice is attached. I understand that this amount will not be included in my taxable wages on Form W-2.

2. Reimburse me directly. Receipts documenting my moving expenses are attached. I understand that deductible expenses per IRS rules will not be included in my taxable wages on Form W-2. Nondeductible expenses per IRS rules will be included in my taxable wages on Form W-2 and taxes will be withheld from the reimbursement amount. (Reference IRS Publication 521, Moving Expenses, at http://www.irs.gov/) (To expedite reimbursement, please provide documentation supporting both the expense (invoice) and payment (credit card receipts or cancelled checks).

TOTAL AMOUNT TO BE PAID/ REIMBURSED

ENTER THE INFORMATION ONLINE, THEN PRINT THE COMPLETED FORM, ATTACH APPROPRIATE DOCUMENTATION, OBTAIN APPLICABLE SIGNATURES, AND SUBMIT TO THE SFA PAYROLL OFFICE.