Employee Reimbursement Form

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Employee Reimbursement Form

An employee reimbursement form is a document that an employee submits to their employer to request repayment for out-of-pocket expenses incurred on the company’s behalf. Employees can request reimbursements for travel, lodging, meals, mileage, and office supplies if company policy permits.

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Last updated July 26th, 2025

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An employee reimbursement form is a document that an employee submits to their employer to request repayment for out-of-pocket expenses incurred on the company’s behalf. Employees can request reimbursements for travel, lodging, meals, mileage, and office supplies if company policy permits.

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Mileage

The IRS has set the claimable rate for mileage at $0.67 per mile (as of this writing).[1]

Deductions

Federal law mandates that deductions from wages for expenses are not legal if they reduce the employee’s wage below the federal rate of $7.25 (as of this writing).[2]

States That Require Employee Reimbursement
State Details Statute
California
  • Employers have to reimburse for all necessary expenses employees incur due to their job
 § 2802
Illinois
  • Employers must reimburse all necessary expenditures or losses
  • Employees must submit documentation within 30 calendar days of the expense
 820 ILCS 115/9.5
Iowa
  • Expenses must be either reimbursed in advance of expenditure or with 30 days of the submission of the reimbursement form
 § 91A.3(6)
Massachusetts
  • Employee’s must be reimbursed for travel expenses if they are required to travel to a place that is not their ordinary workplace.
 § 454 CMR 27.04(4)
Minnesota
  •  Employers must reimburse terminated employees for certain expenses such as uniforms, purchased or rented equipment, consumable supplies, and certain travel expenses.
 § 177.24 (Subd. 5)
Montana
  • Employers must reimburse all expenses incurred to employee as a direct consequence to their job or obedience to the employer
  • This does not cover expenses incurred for doing things that are typical risks for the employee’s job
 § 39-2-701
New Hampshire
  • Employers must reimburse expenses to an employee made at the request of the employer and are outside the employee’s normal job and are not covered by their wage
  • Reimbursement must be made within 30 days of the employee’s submission
 § 257:57
New York
  • Reimbursement must be made to employee’s if it is within a written employment agreement
 § 198-C
North Dakota
  • Reimbursement required unless incurred for typical job risks
 §§ 34-02-01, 34-02-02
South Dakota
  • Employee’s must be indemnified for expenses incurred for performing their duties or at their employers request
  • Not required to be reimbursed for ordinary risks of doing business
 §§ 60-2-1, 60-2-2

Sample

PDF, MS Word, ODT

[EMPLOYER NAME]
EMPLOYEE REIMBURSEMENT

EMPLOYEE INFORMATION

Employee Name: [EMPLOYEE NAME] Employee ID #: [EMPLOYEE ID#]
Department: [EMPLOYEE DEPARTMENT] Contact Number: [EMPLOYEE PHONE #]
Contact email: [EMPLOYEE EMAIL]
Business Purpose: [BUSINESS PURPOSE OF EXPENSE]

EXPENSE INFORMATION

Date Description Payment Method Cost

 

ATTACH ALL RECEIPTS                                                              Total: [TOTAL AMOUNT $]

SIGNATURES

Employee Signature: ________________________ Date: ______________
Approval Signature: ________________________ Date: ______________
Approver Name: [APPROVER NAME]

Sources

  1. IRS – Standard Mileage Rates
  2. U.S. Dept. of Labor – Basic Wage Standards