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Mileage Reimbursement Form

Mileage Reimbursement Form

This is to certify that [Volunteer's name], of [Address], [City], [State] [ZIP Code], who performed services at [Address], [City], [State] [ZIP Code], has performed volunteer services described and listed below.

Organization

, located at

Community services

Date of the services: [Date]. Number of services: [Many Services Has Volunteer]. Type: [Type]. Place: [Place]. Duration: [Long Did It Take]. Time spent: [Time spent]. Signed: [Date of signing].

Supervisor

[Name], [Position], [Email], [Phone number], [Name]. Extra information: [Extra information].

Supervisor's signature: ___________________

Date: [Date] Volunteer's signature:___________________

Party 1

________________

Signature

Date: ________________

Party 2

________________

Signature

Date: ________________

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What Is a Mileage Reimbursement Form?

A Mileage Reimbursement Form in the United States organises the details a party must supply for the purpose it serves.

The IRS standard mileage rate for business use of a personal vehicle is published annually in an IRS Revenue Procedure (the 2024 rate is 67 cents per mile under Rev. Proc. 2024-8). Employers may choose to reimburse at this rate, at a higher rate, or at a lower rate. Reimbursements at or below the IRS standard rate under an accountable plan (as defined in Treasury Regulation Section 1.62-2) are not taxable income to the employee and are deductible by the employer. Reimbursements exceeding the IRS rate or paid under a non-accountable plan are treated as taxable wages subject to income tax withholding, Social Security, and Medicare taxes.

Several states impose independent requirements for mileage reimbursement. California Labor Code Section 2802 requires employers to indemnify employees for all necessary expenditures incurred in the discharge of their duties, including mileage. Illinois (820 ILCS 115/9.5) enacted similar mandatory reimbursement requirements. Massachusetts, Montana, New Hampshire, North Dakota, and South Dakota have comparable statutes. In these states, failure to reimburse employees for business mileage can result in civil penalties, wage claims, and attorneys' fee awards.

For an accountable plan to qualify under IRS rules, the employee must substantiate expenses with adequate records (dates, destinations, business purpose, and mileage) and return any excess reimbursement within a reasonable time. The mileage reimbursement form serves as this required substantiation.

When Do You Need a Mileage Reimbursement Form?

When employees use their personal vehicles for client visits, sales calls, job site inspections, or any travel between work locations that is not a regular commute — which the IRS does not consider reimbursable business mileage.

When delivery drivers, field technicians, real estate agents, or other mobile employees accumulate significant weekly mileage that must be tracked and reimbursed to comply with state expense reimbursement laws under statutes like California Labor Code Section 2802.

When an employer operates an accountable plan under IRC Section 62(c) and needs contemporaneous documentation of business mileage to maintain the plan's tax-advantaged status and avoid having reimbursements reclassified as taxable wages.

When employees travel between multiple work sites during a single workday, as the IRS treats travel between work locations (not from home to a regular office) as deductible business mileage.

When an employee uses a personal vehicle for business because a company vehicle is unavailable, and the employer has a policy of reimbursing the difference.

Failing to maintain proper mileage records exposes employers to IRS audit risk (potential reclassification of reimbursements as taxable income), state labor law violations with penalties and interest, and employee disputes over unreimbursed expenses.

What to Include in Your Mileage Reimbursement Form

Employee identification — full name, department, employee ID number, and supervisor name for approval routing.

Reporting period — the date range covered by the reimbursement request, typically aligned with pay periods or monthly reporting cycles.

Trip-by-trip detail — for each trip, the date of travel, starting location, destination, business purpose (client name or meeting description), and round-trip miles driven. The IRS requires this level of detail for adequate substantiation under Treasury Regulation Section 1.274-5T.

Total miles driven — the aggregate business miles for the reporting period, clearly separated from personal or commuting miles, which are not reimbursable.

Reimbursement rate applied — the per-mile rate used to calculate the reimbursement, whether the current IRS standard mileage rate or a company-specific rate. If the company rate exceeds the IRS rate, the excess must be reported as taxable income.

Total reimbursement amount — the calculated dollar amount (total business miles multiplied by the applicable rate), clearly stated for payroll processing.

Odometer readings — some employers require beginning and ending odometer readings for each trip or for the reporting period to verify mileage accuracy.

Employee certification — a statement signed by the employee certifying that the reported mileage represents actual business travel, that no personal miles are included, and that the information is accurate to the best of their knowledge.

Supervisor approval — a signature line for the employee's direct supervisor or manager to review and approve the reimbursement request before submission to payroll or accounting.

Submission deadline — the date by which the form must be submitted. Under IRS accountable plan rules, expenses must be substantiated within a reasonable period, which the IRS safe harbor defines as 60 days after the expense is incurred.

Cite this page

Reference this free template in an article, syllabus, or research note:

APA

Forms Legal. (2026). Mileage Reimbursement Form (United States) [Legal document template]. Forms Legal. https://forms-legal.com/usa/employment/hr-forms/mileage-reimbursement-form

MLA

"Mileage Reimbursement Form (United States)." Forms Legal, 2026, https://forms-legal.com/usa/employment/hr-forms/mileage-reimbursement-form.

BibTeX
@misc{formslegal-mileage-reimbursement-form,
  author       = {{Forms Legal}},
  title        = {Mileage Reimbursement Form (United States)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/usa/employment/hr-forms/mileage-reimbursement-form}},
  note         = {Free legal document template. Based on Fair Labor Standards Act (29 U.S.C. §201-219)}
}

Also available for these jurisdictions:

Frequently Asked Questions

Based on Fair Labor Standards Act (29 U.S.C. §201-219) — Template last modified June 2026Verify the source →

This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer

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