Travel Card Missing Itemized Receipt Form

Travel Card Missing Itemized Receipt Form

Submitter Email*

Submission of a Missing Receipt Form is an acknowledgement by the cardholder or delegate of a cardholder made a good-faith effort to obtain a copy of the missing receipt directly from the vendor despite the absence of proper document for reconciliation as outlined in HBP Part 11.5.4 (Receipts).

Submission Date*

By checking this box, you acknowledge that all efforts were made to obtain a copy of the itemized missing receipt(s).

Yes, an attempt was made to collect a copy of the receipt(s).*

Cardholder Name*

Provide first and last name of cardholder

Cardholder UT EID*

UT EID is required

Last 4 Digits of Card

Select the number of missing receipts*

1 Missing Receipt

Up to 5 Missing Receipts

Up to 10 Missing Receipts

Receipt Information*

Provide the vendor name, transaction date, transaction amount and description of the item for each missing receipt.

Documentation*

Did this transaction(s) require an RTA or any forms, documentation, or approvals?

Yes

RTA Information*

Provide the RTA number(s) associated to the missing receipt. If there is no RTA, provide justification as to why there is no RTA.

File Upload for statement and/or documentation, forms, etc.*

Please upload the statement associated with the missing receipt(s). If you have an OOEF or any supporting documentation you may attach that as well.

Drag and drop files here or

CSU*

Select

Department Name*

Send me a copy of my responses

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