Research Corporation of the University of Hawaiʻi

Research Corporation of the University of Hawaii Employee Relocation Allowance Worksheet for W-2 Reporting of Moving Expenses
Campus:
Date:
Appointee’s Name
SS#
DEPARTMENT
APPOINTEE’S TITLE:
APPOINTMENT DATE:
DATE DEPARTED:
DATE ARRIVED:
ADDRESS FROM WHICH RELOCATED:

Deductible Moving Expenses (Reportable/Non taxable)
1. Transportation and lodging expenses to new residence
(including those incurred on the arrival date)
Airfare (Total)
Mileage (____ miles x ____ = Fed rate)
Lodging
Taxi
2. Moving expenses for household goods and personal effects
Shipping
Sub-total deductible moving expenses
(these amounts will be reported as non-taxable moving expenses in the pay period processed and identified with a code P on your IRS Form W-2)

Non Deductible Moving Expenses (Reportable/Taxable)
1. Mileage (___ miles x ___ = B.U. rate less Fed rate)
2. Meal expenses
3. Pre-move house hunting expenses
4. Temporary living expenses
5. Expenses of selling or leasing old residence
6. Expenses of purchasing or leasing new residence
7. Others:
Sub-total non-deductible moving expenses
(these amounts will be included in your gross earnings in the pay period processed, identified with a code T on your IRS Form W-2, and Federal, State, FICA, & Medicare withholdings deducted.)

TOTAL REIMBURSEMENT

Note to Appointee: This form provides you the information you need to calculate your moving expense deduction. It shows the amount of any reimbursement made to you. This form is not a verification of your moving expenses. It only shows the amounts your employer reimbursed you for your move. These amounts may differ from the amounts you actually spent.

Form 17-A (02/01/03)