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: ________________
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:
Forms Legal. (2026). Mileage Reimbursement Form (United States) [Legal document template]. Forms Legal. https://forms-legal.com/usa/employment/hr-forms/mileage-reimbursement-form
"Mileage Reimbursement Form (United States)." Forms Legal, 2026, https://forms-legal.com/usa/employment/hr-forms/mileage-reimbursement-form.
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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
A Mileage Reimbursement Form creates a clear written record of an employment decision or communication between an employer and an employee. American employment is presumed at-will in every state except Montana, meaning either party can end the relationship for any lawful reason, so a documented Mileage Reimbursement Form helps both sides understand the terms, dates, and expectations involved. A well-drafted Mileage Reimbursement Form states the relevant facts plainly — names, dates, position, and the action being communicated — which reduces misunderstanding and supports the employer's records if a dispute later arises. Federal laws including Title VII of the Civil Rights Act, the Age Discrimination in Employment Act, and the Fair Labor Standards Act shape how employment decisions must be made and described, so the language should be accurate and free of discriminatory references. Keeping a signed or acknowledged copy of the Mileage Reimbursement Form in the personnel file gives the employer a consistent paper trail.
A Mileage Reimbursement Form can create binding obligations depending on its wording, even in an at-will employment system. Most US employment is at-will, but a Mileage Reimbursement Form that promises specific terms — such as a defined severance amount, a bonus, or a fixed notice period — may be enforced as a contract or under promissory estoppel if the employee reasonably relies on it. To keep a Mileage Reimbursement Form from unintentionally altering at-will status, many employers include language confirming that the document does not create a contract of continued employment. Anti-discrimination statutes such as Title VII and the Americans with Disabilities Act still govern the underlying decision regardless of how the letter is phrased. An employer issuing a Mileage Reimbursement Form should state only what it intends to commit to, because vague promises can later be read as enforceable obligations the employer did not mean to make.
A Mileage Reimbursement Form is legally binding in the United States once the parties capable of contracting sign it with the intent to be bound under Fair Labor Standards Act (29 U.S.C. §201-219). American contract law, drawn from the Restatement (Second) of Contracts and each state's common law, recognizes a Mileage Reimbursement Form as enforceable when it shows offer, acceptance, consideration, and reasonably definite terms. Courts in the state whose law governs the agreement will hold the parties to its written terms unless a party proves fraud, duress, mistake, unconscionability, or that the subject matter is illegal. A signed Mileage Reimbursement Form carries more evidentiary weight than an oral understanding because the writing fixes what each party promised and reduces later disputes over who agreed to what. To strengthen enforceability, the parties should each keep an original signed copy, date their signatures, and complete every blank rather than leaving terms open to interpretation by a judge.
A Mileage Reimbursement Form can be signed electronically and the electronic signature carries the same legal effect as a handwritten one in nearly every US state. The federal Electronic Signatures in Global and National Commerce Act (ESIGN Act, 15 U.S.C. § 7001) and the Uniform Electronic Transactions Act (UETA), adopted by 49 states, provide that a record or signature may not be denied legal effect solely because it is in electronic form. To rely on an e-signature, the parties should intend to sign, consent to do business electronically, and keep a copy of the completed Mileage Reimbursement Form that accurately reflects the terms. A small number of documents — such as wills, certain family-law filings, and some notices — are excluded from UETA and may still require wet ink, so the parties should confirm the document type is eligible. For ordinary agreements, a typed, drawn, or click-to-sign signature on a Mileage Reimbursement Form is valid and admissible as evidence of the parties' assent.
A Mileage Reimbursement Form is governed primarily by the law of the state where it is signed or where the parties agree it will apply, and the rules differ from one state to another. While the core contract principles — offer, acceptance, consideration, and capacity — are consistent nationwide, states set their own requirements on matters such as witnessing, notarization, recording, limitation periods, and mandatory disclosures. A Mileage Reimbursement Form valid in one state may need extra formalities to be effective in another, which matters when the parties live in different states or the subject of the agreement is located elsewhere. Including a governing-law clause that names a single state reduces uncertainty about which rules apply if a dispute arises. The parties should confirm the requirements of the state whose law controls the Mileage Reimbursement Form before signing, because following the wrong state's formalities can leave the document unenforceable or vulnerable to challenge.
A Mileage Reimbursement Form can be prepared without a lawyer in routine situations, and many employers use a clear template to keep communications consistent. US law does not require attorney involvement for an ordinary employment letter, but legal review is prudent when the document waives claims, promises severance, or addresses a termination that could raise discrimination or retaliation concerns. For example, a separation document that asks an employee 40 or older to release age claims must meet the Older Workers Benefit Protection Act's specific requirements, including a 21-day consideration period and a 7-day revocation period, to be valid. An attorney can confirm a Mileage Reimbursement Form complies with federal and state employment law and does not inadvertently create liability. For straightforward communications, a carefully completed Mileage Reimbursement Form from forms-legal.com gives the employer a reliable record, with legal review reserved for higher-risk matters.
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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