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Run: Per Diem Request Form

Use this Per Diem Request Form to capture trip details, lodging, meals, and incidental expense needs before reimbursement or advance processing. It helps fin...

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Request Type

Request type (required)

Trip purpose (required)

Briefly describe the business purpose of the trip. Keep this to the minimum necessary for audit trail purposes.

Trip approval reference

Optional approval or travel authorization number, if your organization uses one.

Traveler and Destination

Traveler name (required)

Enter the name of the traveler submitting this request or the traveler on whose behalf it is being submitted.

Department

Optional department or team for internal routing.

Destination city (required)

Enter the primary travel city or locality used for GSA rate lookup.

Destination state or region

Optional state, province, or region if needed to identify the correct locality.

Is the lodging location the same as the destination locality? (required)

Lodging location

Shown only if lodging is in a different locality than the destination. Enter the city/locality used for lodging rate calculation.

Trip Dates and Duration

Departure date (required)

Return date (required)

The date the traveler returned or will return from the trip.

Number of overnight stays (required)

Enter the total number of nights away from home.

Number of travel days

Optional total number of days for internal review.

Lodging, Meals, and Incidentals

Was lodging provided by the host or covered separately? (required)

Were any meals provided at no cost?

Select all meals that were provided and should be excluded from the per diem calculation.

Are incidental expenses included in this request? (required)

Incidental expenses amount

Enter the incidental amount requested, if applicable and allowed by policy.

Special rate or exception notes

Use this field only if the request needs a policy exception, split locality rate, or other explanation for review.

Payment Details and Attestation

Preferred payment method (required)

Employee ID

Optional internal identifier for routing and audit trail. Do not enter SSN or other sensitive identifiers.

Consent and accuracy acknowledgement (required)

I confirm the information provided is accurate, I understand this form may be used for audit trail and payment processing, and I consent to the collection of the PII entered here for that purpose.

Yes No N/A

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Email (required)

Your name (optional)

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