Mileage Reimbursement Form

Mileage Reimbursement Form

A mileage reimbursement form records the work-related trips made by an employee in their personal vehicle. The completed document is submitted to their employer to provide the trip reason, miles driven, and reimbursable vehicle costs (based on the IRS’s yearly per-mile rate).

Last updated August 6th, 2025

A mileage reimbursement form records the work-related trips made by an employee in their personal vehicle. The completed document is submitted to their employer to provide the trip reason, miles driven, and reimbursable vehicle costs (based on the IRS’s yearly per-mile rate).

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IRS Mileage Rate

The IRS updates the mileage reimbursement rate annually, set in cents per mile. The rate is the maximum amount that can be reimbursed without becoming taxable income.

The standard mileage rate approximates the average cost of using a personal vehicle for business trips, including gas, maintenance, and depreciation. The same rate is used for electric vehicles (EVs), covering electricity, battery wear, and maintenance expenses.[1]

Employees may report actual vehicle costs to their employer instead of using the standard rate, in which case the amount may exceed the rate tax-free if properly documented.[2]

How Mileage Reimbursement Works

  1. Complete form. Employee tracks the work-related miles driven on a mileage reimbursement form. Related expenses may be listed if they will also be reimbursed.
  2. Submit to employer. The form is submitted to the employer. The employer reimburses the employee for the approved amount.
  3. Keep in records. The employer files the form in their records, which can be referenced if the IRS performs an audit.

Sample

Download: PDF, MS Word, ODT

MILEAGE REIMBURSEMENT FORM
GENERAL INFORMATION

Employee Name: [EMPLOYEE NAME] Employee Department: [EMPLOYEE DEPARTMENT]
Employee Title: [EMPLOYEE TITLE]  Employee ID #: [EMPLOYEE ID #]
Employer Name: [EMPLOYER NAME]  Date: [MM/DD/YYYY]

TRIP RECORDS

Date [MM/DD/YYYY] Mileage Cost [MILEAGE COST]
Purpose [TRIP REASON] Other Fees [OTHER FEES]
Mileage [TRIP MILEAGE] Total [TOTAL AMOUNT]
Date [MM/DD/YYYY] Mileage Cost [MILEAGE COST]
Purpose [TRIP REASON] Other Fees [OTHER FEES]
Mileage [TRIP MILEAGE] Total [TOTAL AMOUNT]
Date [MM/DD/YYYY] Mileage Cost [MILEAGE COST]
Purpose [TRIP REASON] Other Fees [OTHER FEES]
Mileage [TRIP MILEAGE] Total [TOTAL AMOUNT]

Final Amount: $[FINAL AMOUNT]

ACKNOWLEDGMENT

I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct.

Employee Signature:                                                               Date: ______________
Print Name: [EMPLOYEE NAME] Title: [EMPLOYEE TITLE]