LQA - Living Quarters Allowance Annual/Interim Expenditures Worksheet (DSSR 130) 

Allowable expenses under the Living Quarters Allowance are reported here to process a claim on the SF-1190. This worksheet is reproducible locally. 

1. Employee name (Last, First, Middle Initial) 2. Agency

2.Pay plan/Series/Grade

 / / 

4. Date of arrival (mm/dd/yy) 

5. Current post/Country of assignment/Locality code

6. If Spouse or Domestic Partner is employed by the U.S. Government: 

Spouse’s or Domestic Partner Name: Quarters Allowance Received:

7. Family domiciled at post

Name of Family Member Relationship 

DOB Except 

Spouse or 

Domestic Partner 

(mm/dd/yy) 

Percentage 

support 

Date of 

arrival 

at post 

Residence 

address 

8. Family domiciled away from post. 

Name of family Member Relationship 

DOB Except 

Spouse or 

Domestic Partner 

(mm/dd/yy)

Percentage 

support 

Date of 

departure 

from post 

Residence 

address 

9. Description of quarters occupied by the employee

Street address (include apartment or room number, if applicable) Date quarters occupied (mm/dd/yy)

Quarters size:

Total rooms (include dining room, living room, kitchen, bedrooms, den and bathrooms)

Total useable area 

 square feet or square meters

Type of quarters:

 House Furnished Privately leased 

 Apartment Unfurnished Government owned or leased 

Multi-Unit - Shared Expenses Personally owned

10. If employee shares quarters, give name of person(s) with whom sharing and employing firm or agency 

Name (Last, First, Middle Initial) Employing firm or agency

11. If employee rents quarters from another U. S. Government employee, give name of that employee and employing agency 

Name (Last, First, Middle Initial) Employing agency

12. If employee lets or sublets portion(s) of his owned or leased quarters: 

(a) Name of sublessee (Last, First, Middle Initial) Sublessee’s employing firm or agency

(b) Amount received from sublessee

(c) Has amount received from sublessee been deducted from

expenses claimed under block 16? 

Yes No

(d) Date let or sublet (mm/dd/yy)

DSSR Section 960 -Worksheet LQA - Page 1 of 3 
LQA - Living Quarters Allowance Annual/Interim Expenditures Worksheet (DSSR 130) 

(a). Have you or your spouse/domestic partner ever received payments for privately owned quarters (POQ) in the overseas area? 

13. Privately Owned Quarters (POQ)

(b) If yes, from whom did you receive the allowances? 

Active Military Dates Allowance Received

DoD Civilian 

(e.g. Air Force, Navy, other agencies etc.) Dates Allowance Received

Contractor 

r

Dates Allowance Received

(c) Do you currently own a POQ in the overseas area? 

(d) Have you ever sold a POQ in the overseas are? 

(e) List all privately owned quarters for which you received allowances in the overseas area (owned or sold). (Enter the information newest to Oldest.) 

From (mm/dd/yyyy) To (mm/dd/yyyy) Physical Address Country

(f) If you answered yes to any question in section 13, documentation must be provided to support dates the POQ allowance was paid.

LQA - Page 2 of 3 
LQA - Living Quarters Allowance Annual/Interim Expenditures Worksheet (DSSR 130) 

14. Employee name (Last, First, Middle Initial) 15. Check one: Estimated or Actual

LQA expenses for the period from to

16. FOR OFFICIAL USE ONLY

Foreign currency rate used to compute expenses listed under item 16 . For Personally Owned Quarters (POQ): date of original 

purchase ; exchange rate at time of original purchase ; and number of years already claimed for rent 

portion of LQA .

17. The following expenses were actually incurred or are estimated for the period claimed in block 14 

Expenses should be supported by lease or rental agreement, receipts 

or cancelled checks. If unobtainable, explain why under block 17, 

Remarks. 

(A) 

Foreign Currency 

Expenses 

(B) 

U.S. Dollar 

Expenses 

(C) 

For official use only 

(D) 

For official use only 

Items (a) through (j) are rent and rent-related expenses

(a) Rent, if leased; monthly rent10% of original purchase price, if

owned (claim limit: 10 yrs)

(b) Garage rental (not to exceed 25% of maximum LQA rate).

(c) Furniture rental (not to exceed 25% of maximum LQA rate).

(d) Insurance on rented property and/or furnishings required by 

local law to be paid by lessee.

(e) Taxes levied by the local government and required by law or

custom to be paid by lessee.

(f) Land rent, if required by local law or custom (applies only to

POQ).

(g) Agent’s fee if mandatory by law or custom and is condition of

obtaining lease. Lessee must pay to landlord, not to agent. 

(h) Apartment/condominium fees

(excluding single family dwelling and POQ).

(i) Interest on a loan from American institution to finance “key 

money” paid to landlord.

(j) Appreciation fee paid directly to landlord. Must appear on 

lease or rental agreement.

Items (k) through (n) are utilities

(k) Heat, gas, fuel

(l) Electricity

(m)Other heat, fuel, electricity, etc. (specify)

(n) Water

(o) Garbage and trash disposal

Total expenses claimed for this period: 

18. Remarks 

19. For official use only (DSSR 135 and 136) 

Quarters allowance group: WF (With Family) WOF (Without Family)

Maximum Annual LQA rate (DSSR 920, column 2, plus 10%, 20% or 30% for additional family members) = 

Daily LQA rate = Annual LQA rate divided by number of days in calendar year. Biweekly rate = daily rate times 14. Any other period = daily rate times number of 

days claimed. 

Beg. Date claimed: End date claimed: Number of days claimed: LQA this period: 

20. Employee statement

I certify that the amounts claimed above were incurred for the period claimed or are estimated to the best of my knowledge for future costs

Employee’s signature Date 

DSSR Section 960 -Worksheet LQA - Page 3 of 3