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California State University, Long BeachCalifornia State University, Long Beach

Authorization For
Public Transit Reimbursement


  1. Web Link to Employee Public Transit Benefits
  2. Review the Detailed Instructions for Public Transit Reimbursement Authorization
  3. Complete the form and use the button below to display a printer friendly version.
  4. Print the "Printer Friendly Version" of the form.
  5. Attach the completed form, receipts, and supporting documentation.
  6. Employee Reimbursement Direct Deposit Authorization form is available by contacting ACCOUNTS PAYABLE at ext. 5-2512.
  7. Email to:
  8. Hard copy delivery:  Sustainable Transportation, Parking & Transportation Office.

Fields with * are required.








Indicate which transit pass you purchased:         

Indicate if you have an employee Parking Permit:         
The employee has read, understands, and agrees to the "CSULB Employee Public Transit Benenfits Administrative Guideline". The employee confirms that the transit passes purchased are for his/her own use in commuting to CSULB in the course of his/her employment, and that no expenses claimed are in the excess of their actual cost. Senior/disabled reduced fare passes are available and should be purchased if applicable. The maximum monthly reimbursement shall not exceed the amount allowed by the IRS to qualify as a non-taxable fringe benefit for transit reimbursements. For purposes of the public transit reimbursement program, the amount reimbursed shall be for the applicable amount, not exceeding $100 (MTA Premium Zones are not indicated). The reimbursement rate is 50% for Parking Pass holders. Transit reimbursement requests must be submitted within the same fiscal year as the purchase. Employee understands that none of these reimbursement plans will qualify for any other reward programs.
Employee Signature Date

Employee Payment Via Direct Deposit is Required. Employee Reimbursement Direct Deposit Authorization form is available by contacting ACCOUNTS PAYABLE at ext. 5-2512.
Submit one new form each FY, and send copy of receipt & transit pass monthly to:

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This is a three step process for the employee

Employee completes and submits the "Employee Information" section of the form and submits to Sustainable Transportation in the Parking & Transportation office;
Employee completes and submits the Employee Reimbursement Direct Deposit Sign-up Form. Employee Reimbursement Direct Deposit Authorization form is available by contacting ACCOUNTS PAYABLE at ext. 5-2512.;
Employee submits photocopy of purchased transit pass and proof of purchase receipts, monthly or quarterly, by email or hard copy, to Sustainable Transportation in the Parking & Transportation office.

Step 1 - The employee completes the forms and submits for approval of Sustainable Transportation

Fill in the plan year of employee reimbursement. Full plan years follow the fiscal year, and run from 7-1 thru 6-30 of the following year. Indicate the fiscal year covered.
Enter the Employee Information requested.
Enter Transit Pass Type to be used for commuting to CSULB, from Description section.

Example: Joe joins the University on August 1st, 2012 and will have year round employment. Joe will commute to CSULB using MTA EZ Tap Card. Joe must complete and sign the employee portion of the form, which will remain in effect until 6/30/2014.

Example image Employee Information Section.

Sample of the Employee Information Section. Allows you to enter all employee informtion and select type of Transit Pass.

The completed Authorization for Public Transit Reimbursement form should be printed and signed by the employee, and submitted to Sustainable Transportation either by email or hard copy.

Hardcopy delivery: Sustainable Transportation, Parking & Transportation office

Step 2 - The employee completes the Direct Deposit form and submits to ACCOUNTS PAYABLE

Employee Reimbursement Direct Deposit Authorization form is available by contacting ACCOUNTS PAYABLE at ext. 5-2512.
Complete the form and submit it to ACCOUNTS PAYABLE. The form must be received by ACCOUNTS PAYABLE before any reimbursement will be made.
Reimbursement will be made by Direct Deposit.

Exceptions to the direct deposit payment method requirement must be authorized by the Vice President of the Division of Administration and Finance.

Step 3 - The employee submits expense documentation monthly or quarterly

The employee is responsible for purchasing the transit pass.
The employee submits photocopies of the transit pass and purchase receipts monthly or quarterly to Sustainable Transportation in the Parking and Transportation office. They may be submitted in hard copy to Sustainable Transportation in the Parking & Transportation office, or by email to:

Supporting documentation:  Photocopies of the transit pass or Tap card must be submitted, along with proof of purchase receipts from the purchase and reloading of transit passes. For on-line and phone reloading of Tap cards, a copy of the credit card statement containing the charges, with personal information other than name redacted, will be acceptable documentation.

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Revision Date 07-2017