TRAVEL COST ANALYSIS

Justification for use of Government aircraft for travel:

**[A. BASIC DATA:]{.underline}**

Dates and time of required times(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 at TDS):

+--------------------------+--------------+---------------------------+
| **[Name]{.underline}**   | **[Hourly    | Annual Salary + 2087 x    |
|                          | Salary]{.    | 1.20 =                    |
|                          | underline}** |                           |
|                          |              | Hourly Salary Rate        |
|                          |              |                           |
|                          |              | **[Note:]{.underline}**   |
|                          |              | 1.20 covers average       |
|                          |              | Fringe                    |
|                          |              |                           |
|                          |              | Benefits. Retirement.     |
|                          |              | Health & Life             |
|                          |              |                           |
|                          |              | Insurance. Medicare.      |
|                          |              | Other Fringes. The 1.20   |
|                          |              | does not include COLA:    |
|                          |              | for Alaska-based          |
|                          |              | employees. Add an         |
|                          |              | additional .25.           |
+--------------------------+--------------+---------------------------+
| \_\_\_\_\_\_             | \$\_\_\_\_   |                           |
| \_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_ |                           |
| \_\_\_\_\_\_\_\_\_\_\_\_ |              |                           |
+--------------------------+--------------+---------------------------+
| \_\_\_\_\_\_             | \_\_\_\_     |                           |
| \_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_ |                           |
| \_\_\_\_\_\_\_\_\_\_\_\_ |              |                           |
+--------------------------+--------------+---------------------------+
| \_\_\_\_\_\_             | \_\_\_\_     |                           |
| \_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_ |                           |
| \_\_\_\_\_\_\_\_\_\_\_\_ |              |                           |
+--------------------------+--------------+---------------------------+
| \_\_\_\_\_\_             | \_\_\_\_     |                           |
| \_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_ |                           |
| \_\_\_\_\_\_\_\_\_\_\_\_ |              |                           |
+--------------------------+--------------+---------------------------+
| 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. Individual    | \_\_\_\_\_\_\_ |
|     ticket cost x \# of required                    | \_\_\_\_\_\_\_ |
|     travelers.]{.underline}**                       |                |
+-----------------------------------------------------+----------------+
| -   Cost of total duty hours away from office or    | \_\_\_\_\_\_   |
|     regular duty station to meet 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, tie down 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 pilot is one of the |                |
|     Government officials required to meet or        |                |
|     perform duties at the TDY location.)            |                |
+-----------------------------------------------------+----------------+
| -   Fuel costs, if not included in the above flight | \_\_\_\_\_\_   |
|     hour rate. Any additional aircraft costs not in | \_\_\_\_\_\_\_ |
|     the above flight hour rate, i.e., tie down      | \_\_\_\_\_\_\_ |
|     fees, overnight parking, etc.                   |                |
+-----------------------------------------------------+----------------+
| > TOTAL Cost by DOI Fleet Aircraft.                 | \$\_\_\_\_\_\_ |
|                                                     | \_\_\_\_\_\_\_ |
|                                                     | \_\_\_\_\_\_\_ |
+-----------------------------------------------------+----------------+

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

  --- ------------------------------------------------------------------ ---------------------------------------------------------------------------------------------- ----------------------------------------------
      Commercial                                                                                                                                                        

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

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

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

                                                                         Purpose                                                                                        
                                                                         \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_   
  --- ------------------------------------------------------------------ ---------------------------------------------------------------------------------------------- ----------------------------------------------

REMARKS: *(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 para. 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]{.underline}**

**[TRAVEL BY THE FOLLOWING CATEGORIES OF PEOPLE:]{.underline}** (See
para. 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**

  -------------------------------------------------------------- -------------------------------------------------------------- ----------------------
  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_   \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_   \_\_\_\_\_\_\_\_\_\_

  Print name of designated approving official                    Signature                                                      Date
  -------------------------------------------------------------- -------------------------------------------------------------- ----------------------