Employee Reimbursement Form

Create Document

Employee Reimbursement Form

An employee reimbursement form is a document that an employee submits to their employer to request repayment for out-of-pocket work expenses. These forms are used to reimburse for travel, lodging, meals, mileage, and office supplies. Proof of payment should be attached when submitted to the accounting department.

Create Document
PDF
Word
ODT

Last updated August 24th, 2025

Document Preview

An employee reimbursement form is a document that an employee submits to their employer to request repayment for out-of-pocket work expenses. These forms are used to reimburse for travel, lodging, meals, mileage, and office supplies. Proof of payment should be attached when submitted to the accounting department.

Downloads: 53
  1. Home »
  2. Employee Forms »
  3. Employee Reimbursement
Mileage Reimbursement Form – Can be used if employees use their personal vehicle for work-related purposes.

Non-Reimbursable Expenses

Depending on company policy, employers may require employees to cover certain company-related expenses, such as uniforms, tools, or equipment. However, federal law prohibits employers from deducting these expenses from the employee’s wage if doing so would reduce their hourly rate below the federal minimum wage ($7.25 as of this writing).[1]

States With Employee Reimbursement Laws
State Details Statute
California
  • Employers must reimburse employees for all necessary expenses or losses incurred while carrying out 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
  • Authorized expenses must be either reimbursed in advance of expenditure or with 30 days of the submission.
 § 91A.3(6)
Massachusetts
  • Employees must be reimbursed for travel expenses if travelling to a place that is not their ordinary workplace.
  • If an employee is required to rent, purchase, or professionally clean a uniform, they must be reimbursed.
 §§ 454 CMR 27.04(4), 27.05(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 through their job.
  • This does not cover losses suffered from the ordinary risks of the employee’s job.
 § 39-2-701
New Hampshire
  • Employers must reimburse employees for job-related expenses paid at the employer’s request unless the expense was a normal condition of employment and wasn’t already otherwise covered.
  • Reimbursement must be made within 30 days of the employee’s submission.
 § 257:57
New York
  • If expense reimbursement is promised in a written agreement, failure by the employer to reimburse within 30 days is treated as a misdemeanor offence.
 § 198-C
North Dakota
  • Employers must cover job-related expenses or losses. This does not include tools or equipment that are also used outside of employment or losses resulting from risks typical to the job.
 §§ 34-02-01, 34-02-02
Pennsylvania
  • Employers with a reimbursement policy must repay the employee within 60 days of the employee’s claim.
 § 260.3(b)
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

Download: 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: [PURPOSE OF EXPENSE]

EXPENSE INFORMATION

Date: [DATE]
Description: [DESCRIPTION]
Payment Method: [PAYMENT METHOD]
Cost: [COST]

Date: [DATE]
Description: [DESCRIPTION]
Payment Method: [PAYMENT METHOD]
Cost: [COST]

Date: [DATE]
Description: [DESCRIPTION]
Payment Method: [PAYMENT METHOD]
Cost: [COST] 

Total: [TOTAL AMOUNT $]

ATTACH ALL RECEIPTS

SIGNATURES

Employee Signature: ________________________ Date: ______________
Approval Signature: ________________________ Date: ______________
Approved by: [APPROVER NAME]

Sources

  1. U.S. Dept. of Labor – Basic Wage Standards