REQUEST/AUTHORIZATION FOR DOD CIVILIAN PERMANENT DUTY

OR TEMPORARY CHANGE OF STATION (TCS) TRAVEL

(Reference: Joint Travel Regulations) (Read Privacy Act Statement on back before completing form.)

SECTION I - REQUEST FOR OFFICIAL TRAVEL

1. DATE (YYYYMMDD) 2. NAME (Last, First, Middle) 3. SOCIAL SECURITY NUMBER

4. NEW POSITION TITLE 5. GRADE OR RATING 6. RETIREMENT PLAN (X one)

FERS CSRS

7. RELEASING OFFICIAL STATION AND LOCATION, OR ACTUAL

RESIDENCE

8. NEW OFFICIAL STATION AND LOCATION, ACTUAL RESIDENCE

OR ALTERNATE DESTINATION

9. REPORTING DATE AT NEW DUTY STATION (YYYYMMDD)

10. TRAVEL PURPOSE (X one)

BETWEEN OFFICIAL STATIONS

RENEWAL AGREEMENT

RETURN FROM OVERSEAS FOR SEPARATION

TEMPORARY CHANGE OF STATION

11. TRANSPORTATION MODE (X as applicable)

GOVERNMENT

COMMERCIAL

POC

RAIL

AIR

MILEAGE RATE: $

12a. PER DIEM FOR EMPLOYEE

(X one)

YES NO

b. PER DIEM FOR DEPENDENT(S) (X)

YES NO

13a. ROUND TRIP TRAVEL FOR HOUSEHUNTING (X one)

YES NO

b. NUMBER OF DAYS

(Including travel)

14a. TEMPORARY QUARTERS SUBSISTENCE

EXPENSE (X one)

YES NO

b. NUMBER OF DAYS

AUTHORIZED 

15a. SHIPMENT OF HOUSEHOLD GOODS

(HHG) (X one)

YES NO

b. NET WEIGHT

AUTHORIZED 

16. OTHER AUTHORIZED EXPENSES (X as applicable)

MISCELLANEOUS EXPENSES

NONTEMPORARY STORAGE OF HHG

SHIPMENT OF POV

PROPERTY MANAGEMENT SERVICES

REAL ESTATE EXPENSES

RELOCATION INCOME TAX ALLOWANCE

RELOCATION SERVICES

TEMPORARY STORAGE OF HHG

TRAVEL ADVANCE AUTHORIZED

IF SO, HOW MUCH? $

17. DEPENDENT OVERSEAS TRAVEL 

(X as applicable)

CONCURRENT

DELAYED

EARLY RETURN

NOT AUTHORIZED

18a. DEPENDENT TRAVEL FROM (Home Address) b. TO (New PDS)

19. DEPENDENTS

a. NAME (Last, First, Middle Initial) b. RELATIONSHIP c. DATE OF BIRTH (YYYYMMDD)

21. ESTIMATED COST

a. PER DIEM

$

b. TRAVEL

$

c. OTHER

$

d. TOTAL

$

22. TRANSPORTATION AGREEMENT

SIGNED (X one)

YES NO

SECTION II - AUTHORIZATION FOR OFFICIAL TRAVEL

23. ACCOUNTING CITATION

24. APPROVING OFFICIAL

a. TITLE

b. SIGNATURE

25. ORDER-ISSUING/AUTHENTICATING OFFICIAL

a. TITLE

b. SIGNATURE c. ORGANIZATION ADDRESS

26. TRAVEL ORDER NUMBER 27. DATE ISSUED (YYYYMMDD)

DD FORM 1614, JUL 1999 PREVIOUS EDITION IS OBSOLETE.

20. REMARKS OR OTHER AUTHORIZATIONS (Use this space for special requirements, leave, excess baggage, etc., or other authorizations. Continue on

back

if necessary.) These orders may be amended by the gaining activity. Expenses/charges not allowed at Government expense are the

financial responsibility of the employee concerned.
PRIVACY ACT STATEMENT

(5 U.S.C. 552a)

DD FORM 1614 (BACK), JUL 1999

AUTHORITY: 5 U.S.C. 5701, 5702; and E.O. 9397 (SSN).

PRINCIPAL PURPOSE(S): Used to issue transportation requests, bills of lading for household goods and automobiles, and as

a supporting authorization for cash payment of travel allowances.

ROUTINE USE(S): In addition to being used by officials and employees of the applicant's Service in determining eligibility, the

information contained herein may be provided to law enforcement personnel investigating those suspected of fraudulently

obtaining allowances. Information also may be disclosed under certain circumstances to other Federal agencies, Members of

Congress, State and local governments, and U.S. and State courts.

DISCLOSURE: Voluntary; however, failure to provide SSN may preclude timely consideration of your request.

20. REMARKS OR OTHER AUTHORIZATIONS (Continued)