Per Diem Taxable Earnings Calculation Worksheet  Printable Version  
 

Name of Traveler:   ___________________________________

SSN:                      ___________________________________

Dates of  Travel:     ___________________________________

Destination:            ___________________________________

                 CONUS Allowed Amount:                                       $ _____________

                 Total of Receipts Documenting Meals and Lodging:   $ _____________

                                          Per Diem Amount:                                                        $_______________

                                          Minus the Larger of the CONUS Amount or Receipts:  $_______________

                                          Taxable Earnings (Excess of Per Diem over Receipts):   $_______________

Name of Preparer: __________________________________________    Ext.: ___________

I, the undersigned traveler, understand that my gross wages for the calendar year will be increased by the amount indicated in the above Taxable Earnings box.

Signature of Traveler:  _______________________________________      Date: ___________

Verified by Pre-Audit:                                                        Processed by Payroll:

Initials: ______   Date: ______                                          Initials: ______  Date:_______

8/20/03