DOE F 1512.1 U.S. Department of Energy OMB Control No.

(10-89) REQUEST FOR APPROVAL OF FOREIGN TRAVEL 1910-2100

All Other Editions Are Obsolete

Replaces DOE F 1512.2

Burden Disclosure Statement

Public reporting burden for this collection of information is estimated
to average 2 hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden, to U.S. Department of Energy, Office of
Organization and Management Systems, Paperwork Reduction Project
(1910-2100), 1000 Independence Ave., SW, Room 4D-024, MA-513.2,
Washington, DC 20585, and to the Office of Management and Budget (OMB),
Paperwork Reduction Project (1910-2100), Washing, DC 20503.

PRIVACY ACT INFORMATION STATEMENT: Collection of the information is
authorized by the Department of Energy Act of 1973, P.L., 96-91.
Disclosure of the personal information requested is mandatory to support
authorization of official travel to foreign countries, and to obtain a
passport.

The information furnished will be used by DOE to authorize travel and
payment of travel expenses, by the Department of State to issue a
passport, and by the General Accounting Office to audit and verify the
accuracy and legality of disbursement.

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

                           PART A. Traveler/Trip    
                           Information              

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

<table>
<colgroup>
<col style="width: 19%" />
<col style="width: 13%" />
<col style="width: 11%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 22%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="16">Section I. Traveler Information. (To Be Completed By
Traveler)</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="9">1. Name (Last, First, Middle)</td>
<td colspan="7">2. Social Security Number</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="9"></td>
<td colspan="7"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>3. Birth Date (DO-MON-YY)</td>
<td colspan="4">4. Birthplace (City, State, Country)</td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2">5. Citizenship</td>
<td></td>
<td></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3">6. DOE Facility</td>
<td></td>
<td colspan="2"></td>
<td colspan="9"><p>7. ( x ) DOE ( ) Contractor ( ) University ( )
Other</p>
<p>Specify name of contractor, university, or other</p></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="3">Princeton Plasma Physics Laboratory</td>
<td></td>
<td colspan="2"></td>
<td colspan="9">Princeton University</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td></td>
<td colspan="2"></td>
<td colspan="9"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="16"><p>8. Employment Address</p>
<p>Post Office Box 451</p>
<p>Princeton, New Jersey 08543</p></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2"><p>9. Work Telephone:</p>
<p>FTS:</p>
<p>Commercial: (609)</p>
<p>Home Telephone: (609)</p></td>
<td colspan="9">10. Division/Department</td>
<td colspan="7"><p>11. Contract Number</p>
<p>DE-AC02-76CHO3073</p></td>
</tr>
<tr class="even">
<td colspan="16">12. Position Tile/Field</td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

+---------+-------------+-------------+---+--------+------+---+------+
| Section |             |             |   |        |      |   |      |
| Ia. For |             |             |   |        |      |   |      |
| Se      |             |             |   |        |      |   |      |
| nsitive |             |             |   |        |      |   |      |
| Travel  |             |             |   |        |      |   |      |
| Only    |             |             |   |        |      |   |      |
| (To Be  |             |             |   |        |      |   |      |
| Co      |             |             |   |        |      |   |      |
| mpleted |             |             |   |        |      |   |      |
| By      |             |             |   |        |      |   |      |
| Tr      |             |             |   |        |      |   |      |
| aveler) |             |             |   |        |      |   |      |
+---------+-------------+-------------+---+--------+------+---+------+
| 13\.    |             |             |   |        |      |   |      |
| I       |             |             |   |        |      |   |      |
| ndicate |             |             |   |        |      |   |      |
| whether |             |             |   |        |      |   |      |
| a DOE   |             |             |   |        |      |   |      |
| s       |             |             |   |        |      |   |      |
| ecurity |             |             |   |        |      |   |      |
| cl      |             |             |   |        |      |   |      |
| earance |             |             |   |        |      |   |      |
| cu      |             |             |   |        |      |   |      |
| rrently |             |             |   |        |      |   |      |
| is held |             |             |   |        |      |   |      |
| or has  |             |             |   |        |      |   |      |
| been    |             |             |   |        |      |   |      |
| held    |             |             |   |        |      |   |      |
| within  |             |             |   |        |      |   |      |
| the     |             |             |   |        |      |   |      |
| last 5  |             |             |   |        |      |   |      |
| years.  |             |             |   |        |      |   |      |
| ( ) Yes |             |             |   |        |      |   |      |
| ( ) No  |             |             |   |        |      |   |      |
|         |             |             |   |        |      |   |      |
| I       |             |             |   |        |      |   |      |
| ndicate |             |             |   |        |      |   |      |
| the     |             |             |   |        |      |   |      |
| highest |             |             |   |        |      |   |      |
| level   |             |             |   |        |      |   |      |
| of      |             |             |   |        |      |   |      |
| cla     |             |             |   |        |      |   |      |
| ssified |             |             |   |        |      |   |      |
| info    |             |             |   |        |      |   |      |
| rmation |             |             |   |        |      |   |      |
| re      |             |             |   |        |      |   |      |
| ceived. |             |             |   |        |      |   |      |
+---------+-------------+-------------+---+--------+------+---+------+
| 14\.    |             |             |   |        |      |   |      |
| Rel     |             |             |   |        |      |   |      |
| ations, |             |             |   |        |      |   |      |
| in      |             |             |   |        |      |   |      |
| cluding |             |             |   |        |      |   |      |
| i       |             |             |   |        |      |   |      |
| n-laws, |             |             |   |        |      |   |      |
| living  |             |             |   |        |      |   |      |
| in      |             |             |   |        |      |   |      |
| Se      |             |             |   |        |      |   |      |
| nsitive |             |             |   |        |      |   |      |
| Cou     |             |             |   |        |      |   |      |
| ntries. |             |             |   |        |      |   |      |
| Include |             |             |   |        |      |   |      |
| re      |             |             |   |        |      |   |      |
| latives |             |             |   |        |      |   |      |
| Within  |             |             |   |        |      |   |      |
| 3       |             |             |   |        |      |   |      |
| Gener   |             |             |   |        |      |   |      |
| ations. |             |             |   |        |      |   |      |
| (If     |             |             |   |        |      |   |      |
| add     |             |             |   |        |      |   |      |
| itional |             |             |   |        |      |   |      |
| space   |             |             |   |        |      |   |      |
| is      |             |             |   |        |      |   |      |
| re      |             |             |   |        |      |   |      |
| quired, |             |             |   |        |      |   |      |
| c       |             |             |   |        |      |   |      |
| ontinue |             |             |   |        |      |   |      |
| on      |             |             |   |        |      |   |      |
| s       |             |             |   |        |      |   |      |
| eparate |             |             |   |        |      |   |      |
| sheet.) |             |             |   |        |      |   |      |
+---------+-------------+-------------+---+--------+------+---+------+
| Name    | R           | Citizenship |   | City   | Co   |   |      |
|         | elationship |             |   |        | unty |   |      |
+---------+-------------+-------------+---+--------+------+---+------+
|         |             |             |   |        |      |   |      |
+---------+-------------+-------------+---+--------+------+---+------+

  ------- ---------------- ------------ --------------- ------- ---------- -------
  Name:                    Social                       Date:              Page 2
                           Security                                        
                           Number:                                         

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

<table style="width:100%;">
<colgroup>
<col style="width: 8%" />
<col style="width: 1%" />
<col style="width: 26%" />
<col style="width: 4%" />
<col style="width: 9%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 12%" />
<col style="width: 8%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="16">Section II. Trip Itinerary. (To Be Completed By
Traveler)</td>
</tr>
<tr class="even">
<td colspan="16">Use additional itinerary pages as required. Account for
the entire time between departure and return. Complete a separate
itinerary for each city/country to visited and for each personal or
leave period. Assign an itinerary number in sequence for each
destination. If any personal leave period is planned, assign an
itinerary number for that time period.</td>
</tr>
<tr class="odd">
<td><p>Itinerary</p>
<p>Number</p></td>
<td colspan="4">15. Destination (City, Country)</td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2">16. Start Date (DD-MON-YY)</td>
<td colspan="5">17. End Date (DD-MON-YY)</td>
</tr>
<tr class="even">
<td></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="4">18. Primary Topic</td>
<td colspan="4"></td>
<td></td>
<td colspan="4">19. Primary Purpose</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="4"></td>
<td></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="4"></td>
<td></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><p>This part of the trip involve:</p>
<p>20. ( ) Yes ( ) No International Agreement?</p></td>
<td colspan="3"></td>
<td colspan="10">Name:</td>
</tr>
<tr class="even">
<td colspan="3">21. ( ) Yes ( ) No Classified information?</td>
<td colspan="13">22. ( ) Yes ( ) No Sensitive topic?</td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="13"></td>
</tr>
<tr class="even">
<td colspan="16"><p>23. Provide further details concerning subject
matter to be discussed, including papers, lectures, etc..</p>
<p>(Restrict response to no more than 3 lines (240 characters), to
permit entry into FTMS.)</p></td>
</tr>
<tr class="odd">
<td colspan="16">24. ( ) Yes ( ) No Conference, Seminar, Symposium,
Workshop, involving 3 or more countries? If yes, Name:</td>
</tr>
<tr class="even">
<td colspan="12"></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="16"></td>
</tr>
<tr class="even">
<td colspan="16">25. ( ) Yes ( ) No Other Meetings? If yes, Name:</td>
</tr>
<tr class="odd">
<td colspan="2">Contacts</td>
<td colspan="2">Name</td>
<td colspan="6">Affiliated Institution</td>
<td colspan="6">Facility To Be Visited</td>
</tr>
<tr class="even">
<td colspan="2">26. Host:</td>
<td colspan="2"></td>
<td colspan="6"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td colspan="2">27. Other:</td>
<td colspan="2"></td>
<td colspan="6"></td>
<td colspan="6"></td>
</tr>
</tbody>
</table>

<table style="width:100%;">
<colgroup>
<col style="width: 8%" />
<col style="width: 1%" />
<col style="width: 26%" />
<col style="width: 4%" />
<col style="width: 9%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 12%" />
<col style="width: 8%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p>Itinerary</p>
<p>Number</p></td>
<td colspan="4">15. Destination (City, Country)</td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2">16. Start Date (DD-MON-YY)</td>
<td colspan="5">17. End Date (DD-MON-YY)</td>
</tr>
<tr class="even">
<td></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="4">18. Primary Topic</td>
<td colspan="4"></td>
<td></td>
<td colspan="4">19. Primary Purpose</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="4"></td>
<td></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="4"></td>
<td></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"><p>This part of the trip involve:</p>
<p>20. ( ) Yes ( ) No International Agreement?</p></td>
<td colspan="3"></td>
<td colspan="10">Name:</td>
</tr>
<tr class="even">
<td colspan="3">21. ( ) Yes ( ) No Classified information?</td>
<td colspan="13">22. ( ) Yes ( ) No Sensitive topic?</td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="13"></td>
</tr>
<tr class="even">
<td colspan="16"><p>23. Provide further details concerning subject
matter to be discussed, including papers, lectures, etc..</p>
<p>(Restrict response to no more than 3 lines (240 characters), to
permit entry into FTMS.)</p></td>
</tr>
<tr class="odd">
<td colspan="16">24. ( ) Yes ( ) No Conference, Seminar, Symposium,
Workshop, involving 3 or more countries? If yes, Name:</td>
</tr>
<tr class="even">
<td colspan="12"></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="16"></td>
</tr>
<tr class="even">
<td colspan="16">25. ( ) Yes ( ) No Other Meetings? If yes, Name:</td>
</tr>
<tr class="odd">
<td colspan="2">Contacts</td>
<td colspan="2">Name</td>
<td colspan="6">Affiliated Institution</td>
<td colspan="6">Facility To Be Visited</td>
</tr>
<tr class="even">
<td colspan="2">26. Host:</td>
<td colspan="2"></td>
<td colspan="6"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td colspan="2">27. Other:</td>
<td colspan="2"></td>
<td colspan="6"></td>
<td colspan="6"></td>
</tr>
</tbody>
</table>

  ------- ---------------- ------------ --------------- ------- ---------- -------
  Name:                    Social                       Date:              Page 3
                           Security                                        
                           Number:                                         

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

  ------------------------ --- --- -- ----------------- -------------- --- -- --
  Section III. General                                                        
  Trip Information (To Be                                                     
  Completed By Traveler)                                                      

  28\. Place of Departure             29\. Date of      31\.                  
  (City, State, Country)              Departure         Sponsoring            
                                      (DD-MON-YY)       Headquarters          
                                                        Organization          

                                                                              

                                      30\. Date of                            
                                      Return                                  
                                      (DD-MON-YY)                             

                                                                              

  32\. Names and                                                              
  Organizations of                                                            
  Headquarters personnel                                                      
  with whom trip has been                                                     
  coordinated.                                                                

                                                                              

  33\. Names and                                                              
  Organizations of other                                                      
  personnel with whom you                                                     
  are traveling as a team.                                                    

                                                                              

  34\. Benefit to                                                             
  Government (include                                                         
  benefit to present                                                          
  position and the                                                            
  Department)                                                                 

                                                                              

  35\. Comments. Label all                                                    
  comments as referring                                                       
  to: a) Justification                                                        
  statement for trips that                                                    
  are exceptions; b)                                                          
  Organization requesting                                                     
  exception travel; c)                                                        
  Specifying any paper                                                        
  attachments to this                                                         
  form; d) General                                                            
  comments regarding trip                                                     
  request; e) Place of                                                        
  return if not same as                                                       
  28. For Sections a., b.,                                                    
  and d., restrict to                                                         
  three lines or 240                                                          
  characters to permit                                                        
  entry into FTMS. (*If                                                       
  additional space is                                                         
  required, continue on                                                       
  separate sheet.*)                                                           

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

Traveler\'s Signature, I understand that I must submit a trip report
within 30 days of my return.

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

               Signature                              Date (DD-MON-YY)
  ------------ ------------------------------ ------- --------------------

Supervisor\'s Signature, I certify that the above information is
correct.

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

  Name (*Type  Title        Organization     Signature          Date
  or Printed*)                                                  (DO-MON-YY)
  ------------ ------------ ---------------- ------------------ -------------

  --------------- --------------------------- ----------------------------
  Section IV.                                 
  Trip Funding                                
  (To Be                                      
  Completed By                                
  Official                                    
  Responsible for                             
  Travel Funds.)                              
  Costs are                                   
  estimates.                                  

  36\. B&R Code:  a\)                         b\)
  --------------- --------------------------- ----------------------------

37\. DOE Funding Organization(s):

<table style="width:100%;">
<colgroup>
<col style="width: 6%" />
<col style="width: 21%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 18%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 7%" />
<col style="width: 10%" />
<col style="width: 8%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td>a) Lead</td>
<td></td>
<td></td>
<td>b) Other:</td>
<td></td>
<td colspan="2"></td>
<td>e) Other:</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="13">38. Non-DOE Funding Source(s):</td>
</tr>
<tr class="even">
<td colspan="13"></td>
</tr>
<tr class="odd">
<td colspan="6"><p>39. Transportation Cost to DOE Airfare, Round
Trip:</p>
<p>Rental Car:</p></td>
<td colspan="3">$</td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="6"><p>40. Per Diem and Miscellaneous Cost to DOE:</p>
<p>Per Diem:</p></td>
<td colspan="3">$</td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="6">41. Total Cost to DOE</td>
<td colspan="3"></td>
<td colspan="4">$</td>
</tr>
<tr class="even">
<td colspan="6">42. Non-DOE Funding Amount:</td>
<td colspan="3">$</td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="6"></td>
<td colspan="3"></td>
<td colspan="4">$</td>
</tr>
</tbody>
</table>

I certify that sufficient funding is available for this trip.

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

  Name (*Type  Title        Organization     Signature          Date
  or Printed*)                                                  (DO-MON-YY)
  ------------ ------------ ---------------- ------------------ -------------

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

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

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

                           PART B. Reviews &        
                           Approvals                

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

1\. Local Review

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

  Name (*Type  Title        Organization     Signature          Date
  or Printed*)                                                  (DO-MON-YY)
  ------------ ------------ ---------------- ------------------ -------------

2\. Other Review

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

  Name (*Type  Title        Organization     Signature          Date
  or Printed*)                                                  (DO-MON-YY)
  ------------ ------------ ---------------- ------------------ -------------

3\. Other Review

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

  Name (*Type  Title        Organization     Signature          Date
  or Printed*)                                                  (DO-MON-YY)
  ------------ ------------ ---------------- ------------------ -------------

4\. Office Review

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

  Name (*Type  Title        Organization     Signature          Date
  or Printed*)                                                  (DO-MON-YY)
  ------------ ------------ ---------------- ------------------ -------------