United States Department of the Interior

Employee Relocation Agreement and Disclosure Statement – Continental 

United States (CONUS) Move

Conditions of Eligibility and Employee Attestation Statements: 

As a condition of my eligibility for relocation benefits, and in consideration of payment by the Federal Government for

travel, transportation, real estate transactions, storage of household goods, and/or other moving expenses, as may be 

allowable under the Administrative Expenses Act of 1946, Public Law 89-516, and any regulations issued there under by 

the General Services Administration, the Department of the Interior, and its Bureaus and/or Offices; I hereby agree to 

remain in the Federal Government Service for twelve months following the effective date of transfer. 

I attest that all verbal or written statements made by me as to my eligibility for relocation reimbursement are correct. I 

agree that at any time after I have relocated and claimed reimbursement the Department of the Interior, and its Bureaus 

and/or Offices, may require me to provide additional documentation to substantiate my claims.

I attest that neither I nor any member of my immediate family has or will receive duplicate relocation reimbursement as a 

result of either my or their move to my new duty station. I further attest that no third party has or will accept duplicate 

payment of relocation expenses that are related to my or an immediate family members move to my new duty station. 

Employee Liability for Each Agreement: 

The agreement to remain in the service of the Federal Government for twelve months following the effective date of 

transfer is not voided by a subsequent transfer whether such subsequent transfer is at the employee’s request or in the 

interest of the Government, nor is such agreement voided by another service agreement made in connection with a second 

transfer. The liability of the employee for any monies expensed by the United States for his/her travel, transportation, and 

relocation allowances are a separate liability for each service agreement. The liability in each instance is effective for the 

full twelve month period in connection with the transfer for which the service agreement is made. (41 CFR 302-2.14)

In the event that I fail to remain in the Federal Government service for a period of 12 months following the effective date of 

my transfer, unless separated for reasons beyond my control and acceptable to the Agency, and its Bureaus and/or Offices, 

relocation costs reimbursed both to me and on my behalf to a third party services provider, shall be recoverable from me as 

a debt due to the United States (28 U.S.C. 2514).

I am Relocating for the Federal Government as a: New Appointee (41 CFR 302-3.1) Transferring Employee (41 CFR 302-3.100)

Address of Old Duty Station:

Street Address: 

City: State: Zip:

Address of Old Residence:

Street Address: 

City: State: Zip:

I am Married: Yes No

Name of Spouse:

I am in a Committed Relationship and Claim Same Sex Domestic Partnership: Yes No

Name of Domestic Partner:

Note: This service agreement must be executed before travel orders can be authorized. 
Name Relationship Date of Birth

1. 1. 1.

2. 2. 2.

3. 3. 3.

4. 4. 4.

5. 5. 5.

6. 6. 6.

7. 7. 7.

8. 8. 8.

9. 9. 9.

10. 10. 10.

Signature of Employee: Date:

Typed or Printed Name:

Signature of HR Specialist: Date:

Typed or Printed Name:

Note: This service agreement must be executed before travel orders can be authorized.

Names, relationship, and age (if children) of eligible immediate family members who will be moving with the transferee to the new duty station: