Expense Form

Travel Reimbursement Form

Please complete this form to request travel reimbursement. Submission of this form does not guarantee reimbursement. An ASHI staff member will contact you if further information is needed. For assistance, please email info@ashi-hla.org.
Directions for completing this form

Complete this form in its entirety. ASHI reimburses electronically via a billpay software platform called Bill.com, a secure and widely trusted bill payment platform to process payments. Bill.com is used by thousands of companies, accounting firms, and financial institutions—including large banks such as JPMorgan Chase and Bank of America—to streamline their accounts payable and receivable processes. It uses industry-standard encryption and rigorous security protocols to protect sensitive information and ensure secure transactions. If this is your first electronic reimbursement from ASHI, you will receive an email from Bill.com with instructions for connecting your banking details to ASHI for electronic reimbursement.
Forms must be submitted within 30 calendar days of the completion of travel.
Reimbursement Policy
Traveling with an overnight stay:
For travel including an overnight hotel stay, a $100 per diem is allotted for each overnight stay related to ASHI business. This per diem covers meals and all travel related gratuities. You may request reimbursement for ground transportation, tolls, parking, personal vehicle mileage, etc. You will need to include itemized receipts for the items not covered by the $100 per diem.

Traveling with NO overnight stay:
For travel that does not include an overnight hotel stay, a $50 per diem may be claimed. This per diem covers meals and all travel related gratuities. You may request reimbursement for ground transportation, tolls, parking, personal vehicle mileage, etc. You will need to include itemized receipts for the items not covered by the $50 per diem.

For Board, ARB, and educational meetings where food & beverage are provided by ASHI, you may claim a $100 per diem for your travel to and from the meeting. An international (outside North and Central America) member may claim a $200 per diem for travel to and from the meeting. This per diem covers meals and all travel-related gratuities. You may request reimbursement for ground transportation, tolls, parking, personal vehicle mileage, etc. You will need to include itemized receipts for the items not covered by the $100 per diem.

Travel reimbursement requests for ASHI meetings (Annual Meeting, ASHI Educational Workshop, International Summer School or Clinical Informatics Workshop) require an upload of your official invitation letter originally sent from ASHI.

Please review ASHI’s travel reimbursement policy for complete details on reimbursements.

Contact Information
Name*

First NameLast Name
E-mail*
Your E-mail Address
Phone Number*

Country CodeArea CodePhone Number
Payable to address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Reimbursement Details
Are you an Inspector Trainee?
If travel is for an ASHI inspection, please state the institution inspected (ASHI Lab Accreditation Number):*
Location*
Date(s) traveled for ASHI*
What purpose are you requesting reimbursement?*
If you selected "other", please indicate a brief description

You traveled for ASHI business and an overnight stay was required.

You are approved to submit for a $100 per diem for each night you required a hotel stay. This per diem covers meals and all travel related gratuities. You may request reimbursement for ground transportation, tolls, parking, personal vehicle mileage, etc. You will need to include itemized receipts for the items not covered by the $100 per diem.
You traveled for ASHI business and an overnight stay was NOT required.

You are approved to submit for a $50 per diem. This per diem covers meals and all travel related gratuities. You may request reimbursement for ground transportation, tolls, parking, personal vehicle mileage, etc. You will need to include itemized receipts for the items not covered by the $50 per diem.
You traveled for an ASHI meeting (ARB, Board or educational)

Since food & beverage are provided by ASHI, you may claim one $100 per diem for your travel to and from the meeting. An international (outside North and Central America) member may claim one $200 per diem for travel to and from the meeting. This per diem covers meals and all travel-related gratuities. You may request reimbursement for ground transportation, tolls, parking, personal vehicle mileage, etc. You will need to include itemized receipts for the items not covered by the $100 per diem ($200 for travelers outside North and Central America)
Expense Detail

Enter the date on the first row as the "month.day". For example: Ex: 3.14 (March 14th). For all meals, please include the meal gratuity in the total. The itemized gratuities row refers to tips for bellman, housekeeping services and additional required services only.

Expenses List

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
Date
lodging
per diem
itemized breakfast
Itemized lunch
Itemized dinner
Itemized gratuities
Air Transportation
Ground Transportation
Parking
*Other

If an expense is listed under "other" a description must be entered below.
Lodging Total
Per Diem Total
Breakfast Total
Lunch Total
Dinner Total
Gratuities
Air Transportation
Ground Transportation
Parking
Other
Subtotal
Mileage Reimbursement

If you used your personal vehicle for travel for ASHI business, please complete the below.
Did you use your personal vehicle for ASHI travel?

YesNo

Total Miles Driven
Total Amount Due from Mileage
Total from Expense List and Milage
Automobile miles x $0.70/mile (includes reimbursement for gas). Proof of mileage (MapQuest, Google Maps, etc.) is required by auditors. Odometer readings are not considered proof.
I certify*

I certify that all the information entered above is valid and true.
Please upload all receipts here

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Meetings official invitation letter*

Browse Files

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Please verify that you are human by entering the letters in the field below.*
Signature - please use your mouse to sign below.

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	Travel Date	Miles
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Travel Reimbursement Form

Directions for completing this form

Forms must be submitted within 30 calendar days of the completion of travel.

Reimbursement Policy

Contact Information

Reimbursement Details

You traveled for ASHI business and an overnight stay was required.

You traveled for ASHI business and an overnight stay was NOT required.

You traveled for an ASHI meeting (ARB, Board or educational)

Expense Detail

Mileage Reimbursement