Case Information

Case Number(s) *

Judicial District / County *

Case Type *

Travel Expenses Request

Traveling from *

Traveling to *

Will you be traveling out of state? *

Yes

No

Are you requesting reimbursement of expenses? *

Yes

No

Will you be travelling out of state and/or over 100 miles outside the jurisdiction of the court? *

Yes

No

Please indicate the amounts you are requesting for the items below.

(Enter zero if you're not requesting an item. If desired, click "Calculate" to see subtotals or the grand total in dollars. All dollar amounts are automatically calculated when you submit your form.)

Note: For in-state travel in D&N cases, you do not need approval for travel time and mileage.

Airfare $ *

Meals $ *

Hotel $ *

Est. mileage before 1/1/19 (in miles) *

x $0.49/mile =

$0.00

Est. mileage after 12/31/18 (in miles) *

x $0.52/mile =

$0.00

Est. travel time (in hours) *

x $80/hr =

$0.00

Note: Travel time does not include airport/flight time.

Est. other billable time
(in hours) *

x $80/hr =

$0.00

Misc. travel-related expenses (in dollars) $ *

_______________________________________________

Grand Total

$0.00

NOTE: You do not need to submit this form at this time. OCR does not require pre-approval for in-state travel time or mileage in D&N cases.

NOTE: You do not need to submit this form at this time. OCR does not require pre-approval for in-state travel time and mileage if traveling less than 100 miles outside the jurisdiction of the court.