HR 9 - Business Travel and Subsistence Expenses Claim V1.2-6/11/ CCG/VPS *** Please Select ***

Transcription

1 HR 9 - Business Travel and Subsistence Expenses Claim V1.2-6/11/ CCG/VPS *** Please Select *** If this form is received by VPS after the 5th of the month then the employee will miss the normal BACS monthly payroll run Hambleton and Richmond CCG MONTH YEAR HOME POSTCODE Indicate below, the user type by putting an X in the box Hull CCG Scarborough and Ryedale CCG ASSIGNMENT NO - WORK BASE Business User (AfC) or Car/Salary sacrifice scheme car Harrogate and Rural District East Riding of Yorkshire CCG SURNAME HOME TO BASE MILEAGE RETURN MOTOR BIKE Vale of York CCG FORENAME ENGINE cc PEDAL BIKE JOB TITLE VEHICLE REGISTRATION (Non Salary Sacrifice) LEASE CAR USER DEPARTMENT Make Fuel Type Petrol Dies LPG Regular Standar Dr's/Dentists only (NonAfC) Model CCG *** Please Select *** Date (dd-mm-yy) Details of Journey Excess Public Transport Excess Travel recipts Training (Reserve Rate) Passengers Subsistence/Other Expense Bulky Equipment Name Details From To Amount p Receipt (Authorised by Manager) Date Details of Journey Excess Public Transport Excess Travel Training Passengers Page 1 of 8 Bulky Equipment Subsistence/Other Expense Receipt (Authorised

2 Date (dd-mm-yy) Details of Journey Excess Public Transport Excess Travel recipts (Reserve Rate) Bulky Equipment Name Details From To Amount p Receipt (Authorised by Manager) # # TOTALS # - - EMPLOYEE DECLARATION I DECLARE that the travelling and other expenses overleaf have been claimed in accordance with NHS Regulations and were actually and necessarily incurred whilst engaged on business activities to enable performance of my duties required by my employment within the Trust. I FURTHER declare that official travel rate is only claimed for journeys where public transport is not available or considered not practical for that journey. I CERTIFY that a current Insurance Policy is in force for the motor vehicle used above and provides cover for the claimed journeys. Also when used on Trust business or activities full third party cover extends to injury or death of passengers and damage to property. I FURTHER CERTIFY that my claims for "Other Expenses" were actually and necessarily incurred in the performance of Trust business activities. Furthermore, any claim for meals was an essential additional cost. I UNDERSTAND that if I provide false information I may be liable for disciplinary, prosecution and civil recovery proceedings. I consent to the information on this form being used for the purposes of the prevention, detection and investigation of fraud EMPLOYEE SIGNATURE DATE Contact Telephone Number Address: MANAGER DECLARATION I CERTIFY to the best of my knowledge and belief that the claimant was engaged on journeys stated on the dates shown. I am an authorised signatory for my department and I APPROVE payment of the claim, including the payment of mileage rates in excess of public transport rate and other expenses claimed above. I am signing below to declare that the information that I have authorised is accurate. I understand that if I authorise false information on this form actions may be taken against me MANAGER SIGNATURE DATE Manager Cost Centre Number MANAGER NAME MANAGER JOB TITLE Please scan as PDF.file and send via to: CCGWorkflowNotifications@sth.nhs.uk Please ensure subject field of includes: VPDxxx, Assignment Number, Employee name, Form HR9 *** Please Select *** Or via the post to: Victoria Pay Services Coleridge House, Northern General Hospital, Herries Road, Sheffield, S5 7AU. - REF: VPDxxx Any queries relating to Travel Claims please contact VPS on Page 2 of 8

3 Travel and Subsistence Guidance Form Processing Criteria Please scanned PDF.file copy of Travel Claim Forms to VPS: Please ensure subject field of includes: VPDxxx, Assignment Number, Employee name, Form HR9 Postal address is: Victoria Pay Services Coleridge House, Northern General Hospital Herries Road Sheffield, S5 7AU REF: VPDxxx VPS will apply the following criteria when checking forms before input. If the complete form doesn't comply it will be returned to you or your manager. If it's returned then the earliest payment for the hours claimed will be the following month - Your assignment number must be entered on the form - All columns should be totalled - Month and Year should be completed in full - Must be signed by the employee - Must be signed by the manager - No correction fluids should be used. Any amendments should be made by neatly crossing out the error and correcting. - Any corrections should be INITIALLED by the manager

4 - Forms should be submitted in line with local cut offs - Receipt (Authorised by Manager)If this section has been ticked by your manager, then you do not need to send receipts to VPS but you must keep the original receipts themselves in case of any queries. Your Information Please ensure that all details are completed before submitting the form to your manager. Failure to do so could result in delays in payment Month of enter the month the miles were travelled/expenses incurred in full format e.g. January Year enter the year in the format YYYY e.g Assignment No you will find this on your wage slip. Assignment number will always start with your employee number. If you have multiple posts within the organisation, your assignment number for each post will be different. Department This should be as it appears on your wage slip. Job Title This should be as it appears on your wage slip. Home Postcode - Enter the post code of your home address Work Base - Enter the name and postcode of your work base in this box Dr's and Dentists (non AfC only) - put 'X' if you are within the remit of the Doctors and Dentists Review body and not AfC (travel rates remain unaffected) Indicate whether you are a Regular or Standard car user. NHS England Salary Sacrifice - Lease Car - Put 'X' if you are a Lease car user.

5 CAR Put 'X' if you are a car user. Leave blank if you are lease car user. LEASE CAR USER Put 'X' if you are a lease car user. Lease Car Odometer Reading If you have ticked Lease Car then you must quote the odometer reading of the lease car at the end of the claim period Should be entered as DD-MM-YY e.g Date Details of Journey Enter the full details of the journey including starting point, destination and any stages in between. It should detail the reason for the journey. Normal day to day business miles occurred performing business related activities applicable to your job. Enter the number of business miles. This is a standard rate for all car users. For journeys starting/finishing from home deduct your Home to Base Mileage. Excess If your original contracted base has changed and your HR30 Excess Mileage Agreement has been authorised. The difference between your original base and the excess miles you incur to travel to your new base. Training (Reserve Rate)

6 Enter the number of miles travelled. This is paid at the reserve rate for all car users. For journeys starting/finishing from home deduct your Home to Base Mileage. Passengers Enter details of any passengers that you are transporting for the same purpose of the journey. You should include their name and the number of miles for which they travelled with you. Bulky Equipment Enter the number of miles travelled for which bulky equipment transported. For journeys starting/finishing from home deduct your Home to Base Mileage. Subsistence/Other Expense. As with journeys you should provide sufficient detail to support the payment of any subsistence or other expense claim. You need to enter the date from and to as well as the and pence cost. Parking costs should be claimed in this section. Receipts must accompany claims in this column. Always consult the Intranet for the most up to date guidance documents Summary SECTION 17 of Agenda for Change Terms and Conditions

7 You are required to indicate on this form, the type of user you are. As of 1st July 2013 all car users (except lease car users) will be paid the same rate. Summarised below is section 17 of the Agenda For Change Terms and Conditions; the full version is available from this website: If you use a Lease Car (not obtained as part of the salary sacrifice scheme) then put 'X' in LEASE CAR USER and complete FOR LEASE CAR USERS - ODOMETER READING box

8 Business Mileage Rate The new single rate for all car users regardless of engine size is 56p per mile: - Reduces to 20p per mile after 3,500 miles; This rate applies to employees who have a Lease Car through the NHS Lease car salary sacrifice scheme Reserve Mileage Rate Similar to old Public Transport Rate, used for: - Return to work after normal working day - Excess mileage on change of base - When public transport is deemed more appropriate - Some study leave - Lease Car Mileage - This is variable and refers to those who have a non-salary sacrifice car agreement Training Mileage - Business mileage rate when attending courses, conferences, events at employer's instigation - Reserve mileage rate when attendance is not required by employer Method of Calculation - No changes if journeys start and finish at base - Where journeys start and finish at home no longer use "triangle method" - Normal Home to Base miles are deducted from journey actually undertaken Public Transport Excess Travel receipts Use this rate when you are using Public Transport instead of your own vehicle as per your HR30 Excess mileage agreement. This column is used for submitting receipt values and not miles.