Missouri State Monthly Expense Report Form
Summary
The Missouri Office of Administration publishes Form MO 300-1189 (10-2021), a standardized Monthly Expense Report for state employees to document travel, lodging, meals, and mileage for reimbursement. The form includes certification language requiring employees to affirm expenses were necessary for state business and have not been reimbursed from any other source, with fields for approval signatures and accounting coding.
“I hereby certify the above claim is correct, that these expenses were necessary to conduct state business, that payment has been made from personal funds for which I have not been reimbursed, nor will I receive from any source any payment for these expenses.”
About this source
GovPing monitors Missouri OIG for new government & legislation regulatory changes. Every update since tracking began is archived, classified, and available as free RSS or email alerts — 3 changes logged to date.
What changed
The form establishes the standard template Missouri state employees and agencies must use to document and submit travel and expense reimbursement claims. It captures over-night lodging, lunch and dinner per diem rates, standard and fleet mileage, and includes the required employee certification that expenses were necessary for state business and have not been and will not be reimbursed from any other source.
State employees and administrative units should ensure they use the current revision of this form (MO 300-1189, dated 10-2021) for all reimbursement submissions, with appropriate approvals before submission to the Office of Administration.
Archived snapshot
Apr 22, 2026GovPing captured this document from the original source. If the source has since changed or been removed, this is the text as it existed at that time.
STATE OF MISSOURI
MONTHLY EXPENSE REPORT
FOR MONTH OF PAGE ______ OF ______
DEPARTMENT/DIVISION OR INSTITUTIONDO NOT MODIFY RATES OR FORMULAS. EMPLOYEE NAME (LAST, FIRST) VENDOR CODE (LAST 4 DIGITS OF SOCIAL SECURITY NUMBER)
xxx-xx-_______________________
OFFICE ADDRESS WO RK PHONE NO. UNIT/COUNTY LOCATION CODE OR DOCUMENT NO.
OVER- STANDARD RET FLEET BREAK-DATE FROM/TO & PURPOSE NIGHT LUNCH DINNER LODGING OTHER* TOTAL MILES (X) MILES FASTSTAY (X)
TOTALS OF ABOVE 4 TOTALS FROM OTHER PAGES 4 TOTAL STANDARD MILES 4 AT ¢ PER MILE 4 TOTAL FLEET MILES 4 AT ¢ PER MILE 4
TOTAL INSTATE TOTAL OUTSTATE TOTAL REIMBURSABLE EXPENSE 4$ $
DATE *EXPLANATION OF OTHER
I hereby certify the above claim is correct, that these expenses were necessary to conduct state business, that payment has been made from personal funds for which I have not been reimbursed, nor will I receive from any source any payment for these expenses.
APPROVAL SIGNATURE CLAIMANT SIGNATURE DATE
TITLE DATE TITLE OFFICIAL DOMICILE
APPR UNIT ACTIVITY FUNCTION OBJ/SUB JOB NUMBER REP CAT AMOUNTFUND AGCY ORG/SUBVERIFIED BY AND DATE / / / / //CODED BY AND DATE / / / / / /CK CATEGORY / / / / Yes N oHAVE YOU OR AN IMMEDIATE FAMILY MEMBER SERVED IN THE U.S. ARMED FORCES? Yes N oIF YES, WOULD YOU LIKE INFORMATION ABOUT MILITARY-RELATED SERVICES IN MISSOURI?
MO 300-1189 (10-2021) SAM II
0.6200.340
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Source document text, dates, docket IDs, and authority are extracted directly from MO OA.
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