Actual Costs Justification

Travel Information:

Traveler’s Name: ________________________________________

Travel Dates: ___________________________________________

Travel Destination: ______________________________________

Per Diem Rate: $ __________ Requested Rate: $ _____________

Hotel Comparison:

Date: _____________

Hotel#1: __________________ Phone#: ____________ Rate: $ ________

Hotel#2: __________________ Phone#: ____________ Rate: $ ________

Hotel#3: __________________ Phone#: ____________ Rate: $ ________

Justification for requesting actual expenses:

(Include date of call to Travel Management Center)

Traveler’s Supervisor: ________________________________________________

Signature and date

Approve: _________________________ Disapprove: ______________________

Budget Officer/SAO Budget Officer/SAO

Note: If you are unable to secure occupancy in the conference hotel, this form must be submitted to justify

why you were unable to secure a room with the approved conference hotel and/or at the approved conference rate.