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Accountable Plan Reimbursement Form Template

Streamline Your Reimbursement Process Effortlessly

Submitting reimbursement requests can often lead to confusion and delays. This Accountable Plan Reimbursement Form Template is designed for businesses looking to simplify expense claims and enhance process transparency. You can track expenses with ease, ensure compliance with IRS rules, and improve communication between finance teams and employees, all while maintaining documentation accuracy. Plus, the template is adaptable to fit different company policies, making it a valuable resource for any organization. Explore the live template and see how easy it is to get started.

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Employee full name
Work email
Phone number
Employee ID or payroll number
Department or cost center
Manager or supervisor full name
Manager work email
Business purpose of these expenses
Expense period start date
Expense period end date
Expense categories included
Please Specify:
Total amount requested for reimbursement (include currency and amount)
Currency
USD
EUR
GBP
CAD
AUD
Other
Please Specify:
Were any charges paid with a company card?
Yes
No
Amount paid on company card to be excluded (if any)
Are you claiming mileage?
Yes
No
Total personal vehicle miles claimed (if applicable)
Mileage rate used (e.g., 0.67 per mile)
Are you claiming per diem?
Yes
No
Itemized list of expenses (date, vendor, amount, category, business purpose)
Have you provided receipts for all expenses that require them?
Yes
No
Receipt link(s) or shared folder URL
Reason for submission delay (if applicable)
Are any expenses more than 60 days old at time of submission?
Yes
No
Name for payment (if different from employee name)
Mailing address for check (if applicable)
Preferred reimbursement method
Payroll (next cycle)
Direct deposit to bank on file
Paper check mailed
Other
Please Specify:
Employee full name (serves as signature)
Date of certification
I certify the information provided is accurate; expenses are ordinary and necessary business expenses; were paid with my personal funds (unless noted); and any advances have been fully accounted for.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Manager comments
Manager full name
Date of review
Manager decision
Approve
Return for changes
Reject
Scheduled reimbursement date
Reference or voucher number
Finance notes
Finance review status
Approved
On hold
Rejected
Needs more information
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Paper art illustration depicting an Accountable Plan Reimbursement Form template and related design elements

When to use this form

If you reimburse employees or owners for business costs and need the payments to remain non-taxable, use this form to collect proof under your accountable plan. It fits small businesses, S corps, and nonprofits when a team member submits travel, supplies, client meals, or phone bills. For day-to-day claims, pair it with the Expense reimbursement form. For trips by car, add a mileage log using the Mileage reimbursement form. If a receipt is missing, require a signed Lost receipt form. You get clear business purpose, dates, amounts, and attachments so finance can approve faster, document the audit trail, and pay people on time.

Must Ask Accountable Plan Reimbursement Questions

  1. What is the business purpose of this expense?

    Stating the purpose ties the cost to company activity and policy. Without it, reviewers cannot judge necessity or tax treatment.

  2. Who paid for the expense and what is their relationship to the company?

    Identifying whether the claimant is an employee, contractor, or shareholder guides approval routing. It also prevents duplicate or ineligible reimbursements.

  3. On what date was the expense incurred and paid, and what period does it cover?

    Dates verify the charge falls within your policy window and budget period. They also help match charges to trips, events, or monthly statements.

  4. How much is the expense, and what documentation are you attaching (receipt, invoice, mileage log)?

    Amount plus proof supports compliance and speeds audits. It helps approvers validate totals and spot taxes, tips, or non-reimbursable items.

  5. Was any part personal or reimbursed elsewhere, and will you return any excess advance?

    This protects the plan by limiting reimbursement to the business portion only. It confirms unused advances will be returned, keeping payments non-taxable.

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