DEPARTMENT OF THE ARMY 

 MASS TRANSPORTATION BENEFIT PROGRAM 

Outside the National Capital Region 

Application Form 

Form date: 11 January 2023

Please check one:

New enrollment Re-enrollment

Change request Withdrawing

Type of change Effective date:

1. APPLICANT INFORMATION:

Army employment type (please check only one):

Army Active Duty Officer Army Reserve Active Duty Enlisted

Army Active Duty Enlisted Army Civilian Employee

Army National Guard Active Duty Officer Army National Guard Civilian/Mil Tech Employee

Army National Guard Active Duty Enlisted Army Reserve Civilian Employee

Army Reserve Active Duty Officer Army Non-Appropriated Fund Employee

If NAF, please provide 9-digit Standard NAFI Number:

Last name: First name: MI: EDIPI:

Residence City, State, 9-digit ZIP 

Code:

Duty Location Installation/Activity:

Duty Location City, State, 9-digit ZIP 

Code:

Office Telephone (include area 

code):

Work e-mail address: Supervisor Name, Location, Office Telephone (include area code)

Cell Phone Number: Department / School:

Vanpool Coordinator: Vanpool ID:

Vanpool Vehicle License Plate:
2. MASS TRANPORTATION BENEFIT CALCULATION:

Name of Mass Transportation system(s) or company(s) you 

intend to use: Specific type(s) of fare media you require:

Please describe your commute from home to work and back when using mass transportation. See example on the instruction page.

A. WORK SCHEDULE: Enter the total number of workdays per month.

If you work 8 hour workdays, 40 hours per week, enter 22.

If you work 9 hour compressed workdays, 40 hours per week, enter 20.

If you work 10 hour compressed workdays, 40 hours per week, enter 18.

If you work another schedule, enter the number of days you work per month.

A. Total number of workdays

per month:

B. Do you work at home some days?

If YES, enter the number of days per month you work at home.

If NO, enter Zero.

B. Number of days working

from home:

C. Do you work at a Telecommuting location some days?

If YES, and you DO NOT use mass transportation, enter the number of days per month.

If YES, and you DO use mass transportation, enter Zero.

If NO, enter Zero.

C. Number of days working at

telecommuting site:

D. Total number of days per month mass transportation is used: D. TOTAL COMMUTING

DAYS (A-B-C):

E. DAILY commuting cost (use only if you pay a daily fare):

Monthly cost: Multiply your 

daily cost by line D.

F. WEEKLY commuting cost (use only if weekly pass is available):

Monthly cost: Multiply your 

weekly cost by 4.

G. MONTHLY commuting cost (use only if monthly pass is available): Enter your monthly cost.

YOUR CLAIMED MONTHLY COMMUTING COST: 

Enter your actual costs, even if they exceed the current available mass transportation 

benefit. You must claim the least expensive of your daily, weekly or monthly costs.

Enter the lesser of E, F, or G.

As of 1 January 2023, the maximum mass transportation benefit available 

to Federal employees for actual commuting costs is $300 per month. 
3. APPLICANT CERTIFICATION: Please read and sign or initial each item.

I certify that I understand that:

Signature 

____________

I am employed by the U.S. Department of the Army as an active duty military member, civilian employee or nonappropriated fund employee. My claim for benefits is as a Federal employee or military service member, and not 

as a contract employee.

Signature 

____________

I am eligible for a public transportation fare benefit, will only use it for my daily commute to and from work, will not 

transfer it to anyone else, and will not allow anyone else to use it.

Signature 

____________

The mode of transportation for which I am claiming the mass transportation benefit is a qualified means of 

transportation.

Signature 

____________

The monthly transportation benefit I am claiming does not exceed my monthly commuting costs.

Signature 

____________

I will not include parking costs, tolls, or the cost of "holding" a space in a van pool when calculating and 

claiming my monthly commuting costs.

Signature 

____________

I will adjust the amount received based upon extended absence (e.g. leave, TDY or deployment).

Signature 

____________

I will notify my local MTPB Program Manager of any changes in my status, e.g. name change, home 

or work address, change in commuting pattern or cost, or change in duty location or employing 

organization, even if within the Army.

Signature 

____________

Upon withdrawal from the Army MTBP, I will return unused fare media to my local MTBP Program Manager. If I 

have used the fare media for other purposes or converted the fare media to another form of media, I will 

reimburse the Army by check or money order payable to the U.S. Treasury.

Signature 

____________

Van pool owners owners who are drivers or passengers are not eligible to receive the mass transportation benefit, 

nor are van pool drivers who receive compensation for driving eligible to receive the benefit.

4. SIGNATURE AND REVIEW:

APPLICANT: I certify that the above information is true and correct. I further acknowledge that any false statements or misrepresentations 

made by me for the purposes of my certification for this benefit may subject me to criminal, civil or administrative penalties.

APPLICANT SIGNATURE: ______________________________________________ DATE:

SUPERVISOR: I certify that I am the supervisor of this employee, and that he/she is eligible for the program as an Army civilian 

employee, military member, or NAF employee. The employee works at the duty station indicated, and has calculated the benefit based 

on the actual days worked (considering alternate schedules, teleworking, etc.).

SUPERVISOR SIGNATURE: ____________________________________________ DATE: 

MTBP POC REVIEW: __________________________________________________ DATE:
ARMY MASS TRANSPORTATION BENEFIT PROGRAM 

OUTSIDE THE NATIONAL CAPITAL REGION 

APPLICATION FORM 

INSTRUCTIONS FOR COMPLETION 

Privacy Act Statement: Information on the MTBP application is solicited under authority of Public Law 101-509. Furnishing the information 

on this form is voluntary; however, failure to do so may result in disapproval or postponement of an applicant's request for the MTBP benefit. 

The purpose of this information is to facilitate timely processing of the applicant's request, to ensure the participant's eligibility, and to 

prevent misuse of funds involved. 

This certification concerns a matter within the jurisdiction of an agency of the United States. Making a false, fictitious or fraudulent 

certification may render the maker subject to criminal, civil, or administrative action. Substantial violations of any of these certifications may 

impact an employee's security clearance status. Information provided on this form may be audited. 

The Army MTBP application form is a fillable PDF form. To complete the form electronically, click on each block of the form and type in the 

required information. You may also print out the blank form and print or type the information manually. Incomplete or illegible forms will not 

be accepted. 

The MTBP application form is used for four types of participant transactions. Check the applicable block: 

New Enrollment. New enrollments are first-time applicants. Applicants who are enrolling at a new duty location, but were participating in 

the program at their previous location, are also defined as new enrollments. These individuals must formally withdraw from the program at 

their old location and submit a “new enrollment” application at their new location. 

Re-enrollment. Re-enrollments are program participants who have withdrawn, or have been suspended or terminated, and are applying to 

renew their participation at their current location. 

Change request. Change requests include changes to the amount claimed for reimbursement, type of mass transportation, type of fare 

media requested, or personal information, e.g. name change or change to military status (Active/Reserve). Use the drop-down on the form 

to identify the type of change requested. 

Withdrawal. Withdrawals are participants who are formally terminating their participation in the program. Circumstances for withdrawal may 

include change of duty location, retirement, separation, or dismissal. Withdrawal also refers to actions taken by the local POC to suspend 

or terminate a participant's receipt of fare media. Reasons for suspension or termination may include extended absence (e.g. long-term 

TDY, sick leave, deployment) or disciplinary action for non-compliance with program requirements. If you are withdrawing, enter the 

effective date of your withdrawal. 

Part 1, Applicant Information. Complete all information, including all information about the applicant's supervisor. This information is 

required in order to certify the applicant's employment. 

Under Employment Type, check only one of the selections: 

Military members: Active Duty Army military members, and members of the Army National Guard or Army Reserve currently serving on 

active duty, will check the appropriate block for your component and status. Members of the Guard or Reserve who are not currently 

serving on active duty and are not Army civilian employees are not eligible to receive the mass transportation benefit. 

Civilian employees: Check the appropriate block for your employing activity/component. For example, if you are a civilian working for the 

Army Reserve, check that block. Army civilian employees who serve in the Guard or Reserve, but are not currently on active duty, are 

eligible for the program in their civilian status. 

NAF employees: Enter the 9-digit Standard NAFI Number (SNN) number for your location. This information may be obtained from the 

Garrison Director of Morale, Welfare, and Recreation (MWR) Programs or the senior MWR agency official. 

Part 2, Mass Transportation Benefit Calculation. 

Identify the mass transportation system/company and specific type of fare media (e.g. passes, tokens) you intend to use. 

Describe your daily commute to and from work. Example: “I drive my POV to the XYZ train station. At the XYZ train station I catch the ABC 

train and ride it to the LMN stop. At the LMN stop I get off the train and board the #25 Bus. I ride the #25 bus to the corner of Main and Oak 

streets. I get off the bus there and walk one block to my office.” 

Enter the number of days per month that you commute, using the instructions on the form. 

Enter your daily, weekly, and monthly commuting cost, as applicable. Note that weekly and monthly costs should only be entered if a 

weekly/monthly pass is available. Calculate your monthly commuting costs using the instructions on the form. The lower of your daily, 

weekly or monthly cost is the amount you may claim as your commuting cost for purposes of the mass transportation benefit. Enter your 

actual costs, even if they exceed the maximum allowable benefit amount. This information will be useful for calculating your benefit amount 

in the event of future adjustments to the maximum benefit. 

Part 3, Applicant Certification. Read and initial each block, certifying that you have read and understood the statements. 

Part 4, Signature and Review. Sign and date the application form, have your supervisor sign and date it, and submit it to your local MTBP 

POC. The POC will review the form and sign and date it to certify that all required information has been provided. 
Department of the Army

MASS TRANSPORTATION BENEFIT PROGRAM STATEMENT OF UNDERSTANDING (SOU)

REFERENCE: MASS TRANSPORTATION BENEFIT PROGRAM OUTSIDE THE NATIONAL CAPITAL REGION PROGRAM POLICY, PROCEDURES AND

GUIDELINES OFFICE OF THE ASSISTANT SECRETARY OF THE ARMY (FINANCIAL MANAGEMENT AND COMPTROLLER) 1 JULY 2013

I UNDERSTAND THE FOLLOWING:

1. PROGRAM PARTICIPANT KEY RESPONSIBILITIES:

6.6.1.3. Participants must submit a withdrawal application if they choose to withdraw from the program, or when they

depart from their command. Departure includes retirement, separation, dismissal and transfer. The participant must also 

return all unused fare media upon departure.

6.6.1.3.1. When an employee signs their initial application, they certify that they will notify the Installation POC and will

return all unused fare media upon departure.

6.6.1.3.2. If a participant is changing locations, the participant must withdraw from the location they were previously

stationed at and re-enroll with the POC at their new location.

6.6.5. Civilian employees who fail to abide by the terms and conditions of the MTBP may be subject to disciplinary action, up

to and including removal from the Federal service and/or criminal prosecution.

6.6.6. Military members who violate the provisions or fail to abide by the terms and conditions of the MTBP may be subject to 

administrative action and/or punitive disciplinary action under the provisions of the Uniform Code for Military Justice.

2. VAN POOL COORDINATOR KEY RESPONSIBILITIES:

4.7.3.1. The van pool coordinator is responsible for “maintaining a monthly log of van pool ridership and providing that

information to the installation POC as required.” This monthly log accounts for all riders every single work day of the month.

The coordinator is responsible for knowing who rides in their van pool on a daily basis and immediately notifying the program 

POC (G8 Manpower) of any significant changes such as riders using the program less than 50% of the time per month and 

ensuring the rider’s disenrollment from the program due to PCS or retirement.

7.9.5.3. The coordinator should notify the MTBP Installation POC if participants are not using the van pool for more than 50%

of the working days of the month. The coordinator should be prepared to provide ridership records to the Installation POC if

required.

7.9.5.4. The Installation POC may use the log for review of participant ridership. This information may be used to ensure that

riders are complying with MTBP guidelines, recommend adjustments to claimed benefit amounts based on ridership patterns,

require reimbursement from MTBP participants who do not use the van for more than 50% of the working days of the month,

or for other purposes related to van pool use.

7.9.7. A van pool invoice or receipt is required each month to document the actual commuting costs for participants. Invoices

and receipts are to be maintained by the van pool coordinator for twelve months, and must be provided upon request of the

installation POC upon request. The installation POC has the right to request copies of contracts/invoices/receipts at any point

throughout the operation of the van pool for audit trail purposes, to ensure the van pool is in compliance with the regulations

of the MTBP.

For additional resources, please visit https://www.milsuite.mil/book/groups/usafmcom-afs-mass-transportation-benefit-program

Participant 

Name: 

Org/Unit: 

Phone:

E-mail:

Signature:

Vanpool

Coordinator Name:

Org/Unit:

Phone:

E-mail:

Date: Signature: Date: 

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