ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAE
1
DISB-4C, Per Diem/M&IE/Lodging Tax Calculation Worksheet (Effective July 1, 2013)
2
Name:Payoll No.UH ID No.E-DOC No.T DOC No.
3
Last Name, First Name
4
Acutal Rate Paid (Column C)
BU RateOther Than BU
Federal Allow Rate (Column D)
INTRA STATEUS&TERRFOREIGN
5
IntraPer Diem 80.00 - Per Diem CONUS Low 141.00
6
StateM&IE30.00 - CONUS High 226.00
7
(I/S)Same Day Meal Allowance20.00 -
CONUS/OCONUS City Rate
 0.00 0.00 0.00
8
Lodging Total 0.00 - M&IE CONUS Low 45.00
9
Out ofPer Diem 130.00 - CONUS High 58.00
10
StateM&IE 45.00 -
CONUS/OCONUS City Rate
 0.00 0.00 0.00
11
(O/S)Lodging Total - US & Territories 0.00 -
Same Day Meal Allowance
 0.00
12
Lodging Total - Foreign 0.00 -
13
ABCDEFGHI
14
No. of DaysDestinationActual Rate PaidFederal Allow RateActual Less Fed Rate(C-D)Taxable Amt (A*E) Non Reportable (Non Taxable) Amt Total PD/M&IE/ Lodging Rec'dReportable Amt (H-(F+G))
15
Intra State Per Diem & M&IE Calculation
16
 - Per Diem - OCONUS City Rate80.0000.00 - - - - -
17
 - M&IE - OCONUS City Rate30.0000.00 - - - - -
18
 - Same Day Meal Allowance20.0000.00 - - - - -
19
I/S LODGING TOTAL0.00 - -
20
 I/S SUB-TOTALS - - - -
21
I/S - Subcodes
435243504351
22
 Out of State - US & Territories Per Diem Calculation
23
 - Per Diem - CONUS Low Rate130.000141.00 - - - - -
24
 - Per Diem - CONUS High Rate130.000226.00 - - - - -
25
 - Per Diem - CONUS/OCONUS City Rate130.0000.00 - - - - -
26
O/S-US & Territories PD Totals
 - - - -
27
 Out of State - US & Territories M&IE Calculation
28
 - M&IE CONUS Low Rate45.00045.00 - - - - -
29
 - M&IE CONUS High Rate45.00058.00 - - - - -
30
 - M&IE CONUS/OCONUS City Rate45.0000.00 - - - - -
31
O/S-US & Territories M&IE Totals
 - - - -
32
O/S - US & Territories LODGING TOTAL 0.00 - -
33
O/S-US & TERRITORIES SUB-TOTALS
- - - -
34
O/S - US & Territories Subcodes
455245504551
35
 Out of State - Foreign Per Diem & M&IE Calculation
36
 - Per Diem - OCONUS City Rate130.0000.00 - - - - -
37
 - M&IE OCONUS City Rate45.0000.00 - - - - -
38
O/S - Foreign LODGING TOTAL0.00 - -
39
O/S FOREIGN SUB-TOTALS - - - -
40
O/S - Foreign Subcodes
458245804581
41
(Rev 07/22/13)
GRAND TOTAL - - - -
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100