AMFA Local 4

Online - Weekly Per Diem Expense Report

Weekly Per Diem Expense Report
Please fill out the required information below to submit your report.

Submitted by (Name):
Week Ending:
Local:
Purpose of event:
Is PULP time being used for the event?	Yes No
Is this event being held in your home city?	Yes No
Date	Pro rata Status*	City	Per Diem Rate**	% of Rate***	Adjusted Rate (1 x 2)****	Amount Due





Total:
Less: Per Diem Cash Advance
Total Due to Member:
By entering your name, you agree to sign this form. Member Signature:
Date Submitted:

*Pro rata status:

National Expense
Negotiations/Airline __________
JAC Meeting
Other ___________________

**Current per diem rates can be found at: http://www.gsa.gov/perdiemrate

***Travel days will be reimbursed at 75% of the full day rate; members attending full-day pro rata activities in their home city shall also be reimbursed at 75% of the full day rate.

****Example: ($51 x .75 = $38.25)