2026 APTA Home Health Reimbursement Form.xlsx

	A	B	C	D	E	F	G	H	I
1	APTA HOME HEALTH
2	140B Purcellville Gateway Drive, Suite 120, Purcellville, VA 20132 Suite 120 Purcellville, VA 20132
3
4	TRAVEL EXPENSE REIMBURSEMENT REQUEST
5	NAME (PRINT):		Jeremy Foster
6	STREET ADDRESS:		46 Country Ln
7	CITY/STATE/ZIP:		Holcomb, MS 38940
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9	TRAVEL PURPOSE:		APTA HOD
10		From:	7/11/20026		To:	7/14/2026	To:
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12	See Guidelines for reimbursement limits; original receipts must be attached.
13	TRAVEL EXPENSES
14	DATE			7/11/26	7/12/26	7/13/26	7/14/26
15	CAR MILEAGE ( INSERT MILES)						96
16	IRS RATE PER MILE (0.725):						$ 69.60
17	Airfare
18	registration
19	parking			9.00	9.00	9.00	9.00
20	breakfast
21	lunch
22	dinner			13.71	31.75	32.40
23	dine and dash coverage
24	hotel			312.05	312.05	312.05
25	lft from airport to hotel			68.64
26	uber to airport from hotel						46.93
27	Miscellaneous
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30									$ 1,118.65
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33
34	**MISCELLANEOUS EXPENSE RECORD EXPLANATION
35	DATE	NAME OF GUEST (S)			PURPOSE			LOCATION	AMOUNT
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41	è	Jeremy Foster
42	è	EXECUTIVE DIRECTOR APPROVED:
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44	FOR STAFF USE ONLY			Travel	Per Diem	Honorarium	Other
45	PROGRAM/PROJECT #
46	ACTIVITY #
47	LINE ITEM
48	FOR ACCOUNTING USE ONLY
49	CHARGE TO:						DATE PAID:
50							CHECK NO:
51							CHECK PROCESSOR:
52							DOC #:
53							DESCRIPTION:
54	FINANCE APPROVAL:
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