AMD-110

(10/06)

# TRAVEL COST ANALYSIS

Justification for use of a Government aircraft for travel:

A.  [BASIC DATA]{.underline}:

> Dates and time of required time(s) at Temporary Duty Station(s) (TDS):
>
> Location Date Hours required to be on site to
>
> Location Date Hours required to be on site to
>
> Location Date Hours required to be on site to

Manifest (only persons required to be at TDS):

> [Name]{.underline} [Hourly Salary]{.underline}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TOTAL Hours Cost of All Required Travelers \$
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> (*Continue on attached sheet if needed*)

B.  [COST COMPARISON]{.underline}:

> 1\. [Commercial Airline Costs to meet the required TDS locations and
> times.]{.underline} [Individual ticket cost x number of required
> travelers]{.underline}. \$ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   Cost of total duty hours away from office or regular duty station to
    meet the commercial airline schedule.
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   Cost of required per diem and ground transportation.
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TOTAL Cost by commercial transportation **\$**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\. [Leased, Contract, or Rental Aircraft]{.underline}.

1.  Flight hours x flight hour costs \$
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2.  Cost of total duty hours away from office or regular duty station
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3.  Cost of required per diem and ground transportation
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4.  Any additional aircraft or crew costs not included in above hourly
    rate, i.e., standby charges, tiedown fees, overnight
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> parking, extra crew, etc.

TOTAL Cost by Lease, Contract, or Rental aircraft. \$
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> 3\. [DOI --Operated Aircraft]{.underline} -- identify specific
> aircraft: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   Flight hours required x variable flight hour cost. \$
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   Cost of total duty hours away from office or regular duty station.
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   Cost of required per diem and ground transportation.
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   Any additional costs to be incurred that are not included in the
    above flight hour rate. Variable cost of crew, as defined
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> on page 1 of OMB Circular A-126, Attachment B, if not included in the
> flight hour rate. (Do not include pilot costs
>
> here if the pilot is one of the Government officials required to meet
> or perform duties at the TDY location.)

-   Fuel costs, if not included in above flight hour rate. Any
    additional aircraft costs not in the above flight hour rate,
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> i.e., tiedown fees, overnight parking, et.
>
> TOTAL COST by DOI Fleet aircraft. \$
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

C.  [MOST COST EFFECTIVE METHOD]{.underline}:

Commercial

Lease, Contract or Rental -- N# \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
Pilot/Crew
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Purpose
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DOI Fleet \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--N#
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. Pilot/Crew
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Purpose
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[REMARKS]{.underline}: (*Must be completed if other than
most-cost-effective method is chosen*.)

D.  [GENERAL APPROVAL REQUIREMENTS FOR TRAVEL ON GOVERNMENT
    AIRCRAFT]{.underline}:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Print name of designated approving official Signature Date

E.  [SPECIAL APPROVAL REQUIREMENTS FOR REQUIRED USE TRAVEL]{.underline}:
    (See paragraph 11.b. page 6 of OMB Circular A-126)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Print name of designated approving official Signature Date

F.  [SPECIAL APPROVAL REQUIREMENTS FOR USE OF GOVERNMENT AIRCRAFT FOR
    TRAVEL BY THE FOLLOWING CATEGORIES OF PEOPLE]{.underline}:

> (See paragraph 11.c. page 7 of OMB Circular A-126 and paragraph a.,
> page 3-1 of OMB Bulletin No. 93-11)

1\) Senior Executive Branch Officials

2\) Senior Federal Officials

3\) Members of Families of Senior Executive Branch and Senior Federal
Officials

4\) Non-Federal travelers

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Print name of designated approving official Signature Date