+-----------------------------------+-----------------------------------+
|                                   | **Form AD-728 (Rev. 12/88**)      |
+-----------------------------------+-----------------------------------+
|                                   | 1\. AGENCY                        |
+-----------------------------------+-----------------------------------+
| # REQUEST AND AUTHORIZATION       | **     **                         |
+-----------------------------------+-----------------------------------+
| #                                 | 2\. ORGANIZATIONAL UNIT           |
| # FOR HOME TO WORK TRANSPORTATION |                                   |
+-----------------------------------+-----------------------------------+
|                                   | **     **                         |
+-----------------------------------+-----------------------------------+
| 3\. NAME OF EMPLOYEE              | 4\. OCCUPATION OR TITLE           |
+-----------------------------------+-----------------------------------+
| **     **                         | **     **                         |
+-----------------------------------+-----------------------------------+
| 5\. RESIDENT ADDRESS              | 6\. OFFICIAL STATION              |
+-----------------------------------+-----------------------------------+
| **     **                         | **     **                         |
+-----------------------------------+-----------------------------------+
| **7. DISTANCES TRAVELED FROM:**   |                                   |
+-----------------------------------+-----------------------------------+

a\. Residence to Office. **[     ]{.underline}**

b\. Residence to nearest Government or Commercial storage facility
offering service during required hours. **[     ]{.underline}**

**[c. Daily tour of duty - Give each location starting with first
departure *(Home or office, plant, establishment, etc.)* and mileage
between each point. i.e. Home to office-3 miles, Office to field
station - 10 miles, Field station to area office - 4 miles.
     ]{.underline}**

  -----------------------------------------------------------------------
  **8. REASON FOR HOME TO WORK TRANSPORTATION**

  -----------------------------------------------------------------------

a. An intermediate or imminent clear and present danger presents a
threat to the physical safety of the employee\'s person or property.
*(Describe.)*

b. An emergency has created an immediate, unforeseeable temporary need
to provide home-to-work transportation in order to guarantee
uninterrupted performance of the agency\'s mission. *(Describe the
nature of the emergency and the role of the employees to the agency\'s
mission.)*

c. Compelling operational considerations make the provision of
home-to-work transportation essential to the conduct of official
business or would substantially increase the agency\'s efficiency or
economy. *(Describe the circumstances and/or explain how other available
alternatives would involve substantial additional costs to the
Government or expenditures of employee time.)*

> (1) Stationed at a field point with no office and normally proceed
> directly from residence to varying points of duty.
>
> (2) Stationed at a field point with local office, but normally proceed
> directly from residence to varying points of duty.
>
> (3) Frequently required to depart on, and return from, fields trip at
> unusually early or late hours, during which the use of public
> transportation or services of other storage facilities are not
> available or reasonable.
>
> (4) Engaged in law enforcement duties under 31 U.S.C. 1344.
>
> (5) Storage of vehicle at residence due to economical or security
> reasons.

d. Field Work

e. Residence is permanent Official Duty Station.

  ------------------ -------------------------- -----------------------------------
  DESCRIPTION:                                  

  **9. AUTHORIZATION                            
  PERIOD**                                      

  FROM:                                         TO:      

  **10. VEHICLE                                 
  IDENTIFICATION**                              

  Owned              Type of vehicle            
                     *(Describe: i.e., sedan,   
                     truck, etc.)*              

  Leased                                        

  **11.                                         
  CERTIFICATION                                 
  *(See Privacy Act                             
  Statement)***                                 
  ------------------ -------------------------- -----------------------------------

I CERTIFY that the above information is true and correct to the best of
my knowledge. I will not use this vehicle at any time for my personal
convenience or permit others to do so. When parked at or near residence,
vehicle will be kept locked and every precaution taken to guard it
against damage or theft, etc. I understand that use of this vehicle for
other than official purposes makes me subject to suspension without pay
for a period of not less than one month or to removal summarily from
office as provided in 31 U.S.C. 1349(b).

  ------------------ ----------- ------------------ ------- ----------------------- --------------
  SIGNATURE OF                                                                      DATE SIGNED
  EMPLOYEE                                                                          

                                                                                         

  **12.                                                                             
  RECOMMENDATION**                                                                  

  APPROVED           SIGNATURE                              TITLE                   DATE

  YES NO                                                                                 

  **13.                                                                             
  AUTHORIZATION**                                                                   

  APPROVED                       EXPLAIN                                            
                                 DISAPPROVAL                                        

  YES NO                                                                            

  SIGNATURE                                         TITLE                           DATE

                                                                                         

  This authorization                                                                
  is not                                                                            
  transferable. A                                                                   
  new application                                                                   
  must be submitted                                                                 
  whenever the                                                                      
  circumstances, as                                                                 
  stated above,                                                                     
  change to such as                                                                 
  extent as to make                                                                 
  continued                                                                         
  authority                                                                         
  questionable. The                                                                 
  approving officer                                                                 
  should be notified                                                                
  immediately when                                                                  
  for any reason                                                                    
  *(such as                                                                         
  transfer,                                                                         
  separation, etc.)*                                                                
  this authority is                                                                 
  no longer                                                                         
  required.                                                                         
  ------------------ ----------- ------------------ ------- ----------------------- --------------