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 Internal Revenue Service (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.
2. Reimburse me directly. Receipts documenting my moving expenses are attached. (To expedite reimbursement, please provide documentation supporting both the expense [invoice] and payment [credit card receipts or cancelled checks].)
NOTE: The taxability of moving expenses will be determined by IRS guidelines. I understand that any taxable amount, whether paid directly to the vendor or reimbursed directly to me, will be included in taxable wages on my Form W-2 and subject to federal income tax and FICA (social security) withholdings.
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.