|
TRAVEL VOUCHER OR SUBVOUCHER |
|
Read Privacy Act Statement, Penalty Statement, and Instructions on back before completing |
|
|
|
form. Use typewriter, ink, or ball point pen. PRESS HARD. DO NOT use pencil. If more space |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
is needed, continue in remarks. |
|
|
|
|
|
|
|
|
|
|
|
1. PAYMENT |
|
|
SPLIT DISBURSEMENT: The Paying Office will pay directly to the Government Travel Charge Card (GTCC) contractor the portion of your reimbursement represen- |
|
|
|
Electronic Fund |
|
ting travel charges for transportation, lodging, and rental car if you are a civilian employee, unless you elect a different amount. Military personnel are required to |
|
|
|
designate a payment that equals the total of their outstanding government travel card balance to the GTCC contractor. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Transfer (EFT) |
|
NOTE: A split disbursement is only necessary when a GTCC is used while on official travel for the Government. |
|
|
|
|
|
|
|
|
|
|
|
|
|
Payment by Check |
|
|
Pay the following amount of this reimbursement directly to the Government Travel Charge Card contractor: |
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2. NAME (Last, First, Middle Initial) (Print or type) |
|
|
|
3. GRADE |
4. SSN |
|
|
|
5. TYPE OF PAYMENT (X as applicable) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TDY |
|
|
|
|
Member/Employee |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6. ADDRESS. a. NUMBER AND STREET |
|
|
b. CITY |
|
|
|
|
|
|
c. STATE |
|
d. ZIP CODE |
|
|
PCS |
|
|
|
|
Other |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Dependent(s) |
|
|
|
DLA |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
e. E-MAIL ADDRESS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10. FOR D.O. USE ONLY |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7. DAYTIME TELEPHONE NUMBER & |
8. TRAVEL ORDER/AUTHORIZATION |
9. PREVIOUS GOVERNMENT PAYMENTS/ |
a. D.O. VOUCHER NUMBER |
|
|
|
|
|
AREA CODE |
|
|
|
|
NUMBER |
|
|
|
|
ADVANCES |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11. ORGANIZATION AND STATION |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
b. SUBVOUCHER NUMBER |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12. DEPENDENT(S) (X and complete as applicable) |
|
|
|
|
13. DEPENDENTS' ADDRESS ON RECEIPT OF |
c. PAID BY |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ORDERS (Include Zip Code) |
|
|
|
|
|
|
|
|
|
|
|
|
|
ACCOMPANIED |
|
|
|
|
UNACCOMPANIED |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
a. NAME (Last, First, Middle Initial) |
b. RELATIONSHIP |
c. DATE OF BIRTH |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
OR MARRIAGE |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14. HAVE HOUSEHOLD GOODS BEEN SHIPPED? |
d. COMPUTATIONS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(X one) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
YES |
|
|
NO (Explain in Remarks) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15. ITINERARY |
|
|
|
|
|
|
|
|
|
|
|
c. |
d. |
|
e. |
f. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MEANS/ |
REASON |
LODGING |
POC |
|
|
|
|
|
|
|
|
|
|
|
a. DATE |
|
b. PLACE (Home, Office, Base, Activity, City and State; |
MODE OF |
FOR |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
City and Country, etc.) |
|
|
|
|
TRAVEL |
STOP |
|
COST |
MILES |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
DEP |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ARR |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
DEP |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ARR |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
DEP |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ARR |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
DEP |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ARR |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
DEP |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ARR |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
DEP |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
e. SUMMARY OF PAYMENT |
|
|
|
|
|
|
|
|
ARR |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) Per Diem |
|
|
|
|
|
|
|
|
|
|
|
|
DEP |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(2) Actual Expense Allowance |
|
|
|
|
|
|
|
|
ARR |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(3) Mileage |
|
|
|
|
|
|
|
|
16. POC TRAVEL (X one) |
|
|
OWN/OPERATE |
|
|
PASSENGER |
|
17. DURATION OF TRAVEL |
(4) Dependent Travel |
|
|
|
|
18. REIMBURSABLE EXPENSES |
|
|
|
|
|
|
|
|
|
|
|
12 HOURS OR LESS |
(5) DLA |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
a. DATE |
|
b. NATURE OF EXPENSE |
|
c. AMOUNT |
d. ALLOWED |
|
(6) Reimbursable Expenses |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MORE THAN 12 HOURS |
(7) Total |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
BUT 24 HOURS OR LESS |
(8) Less Advance |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MORE THAN 24 HOURS |
(9) Amount Owed |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(10) Amount Due |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19. GOVERNMENT/DEDUCTIBLE MEALS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
a. DATE |
b. NO. OF MEALS |
a. DATE |
|
b. NO. OF MEALS |
c. REVIEWER'S PRINTED NAME
21.a. APPROVING OFFICIAL'S PRINTED NAME
22.ACCOUNTING CLASSIFICATION
23.COLLECTION DATA
24. COMPUTED BY |
25. AUDITED BY |
26. TRAVEL ORDER/ |
27. RECEIVED (Payee Signature and Date or Check No.) |
28. AMOUNT PAID |
AUTHORIZATION POSTED BY |
DD FORM 1351-2, MAY 2011 |
PREVIOUS EDITION IS OBSOLETE. |
Adobe Designer 8.0 |
|
|
Exception to SF 1012 approved byGSA/IRMS 12-91. |
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. Section 301; Departmental Regulations; 37 U.S.C. Section 404, Travel and Transportation Allowances, General: DoD Directive 5154.29, DoD Pay and Allowance Policy and Procedures; Department of Defense Financial Management Regulation (DoDFMR) 7000.14.R., Volume 9; and E.O. 9397 (SSN), as amended.
PRINCIPAL PURPOSE(S): To provide an automated means for computing reimbursements for individuals for expenses incurred incident to travel for official Government business purposes and to account for such payments.
Applicable SORN: T7333 (http://privacy.defense.gov/notices/dfas/T7333.shtml).
ROUTINE USE(S): Certain "Blanket Routine Uses" for all DoD maintained systems of records have been established that are applicable to every record system maintained within the Department of Defense, unless specifically stated otherwise within the particular record system notice. These additional routine uses of the records are published only once in each DoD Component's Preamble in the interest of simplicity, economy, and to avoid redundancy. Applicable SORN: http://dpclo.defense.gov/privacy/SORNs/component/dfas/preamble.html.
DISCLOSURE: Voluntary; however, failure to furnish the requested information may result in total or partial denial of the amount claimed. The Social Security Number is requested to facilitate the possible collection of indebtedness or credit to the DoD traveler's pay account for any residual or shortage.
PENALTY STATEMENT
There are severe criminal and civil penalties for knowingly submitting a false, fictitious, or fraudulent claim (U.S. Code, Title 18, Sections 287 and 1001 and Title 31, Section 3729).
INSTRUCTIONS
ITEM 1 - PAYMENT
Member must be on electronic funds (EFT) to participate in split disbursement. Split disbursement is a payment method by which you may elect to pay your official travel card bill and forward the remaining settlement dollars to your predesignated account. For example, $250.00 in the "Amount to Government Travel Charge Card" block means that $250.00 of your travel settlement will be electronically sent to the charge card company. Any dollars remaining on this settlement will automatically be sent to your predesignated account. Should you elect to send more dollars than
ITEM 15 - ITINERARY - SYMBOLS
15c. MEANS/MODE OF TRAVEL (Use two letters)
GTR/TKT or CBA (See Note) - T |
Government Transportation |
- G |
Commercial Transportation |
- C |
(Own expense) |
Privately Owned |
- P |
Conveyance (POC) |
Automobile - A Motorcycle - M
Bus - B
Plane - P
Rail - R Vessel - V
you are entitled, "all" of the settlement will be forwarded to the charge card company. Notification: you will receive your regular monthly billing statement from the Government Travel Charge Card contractor; it will state: paid by Government, $250.00, 0 due. If you forwarded less dollars than you owe, the statement will read as: paid by Government, $250.00, $15.00 now due. Payment by check is made to travelers only when EFT payment is not directed.
REQUIRED ATTACHMENTS
1.Original and/or copies of all travel orders/authorizations and amendments, as applicable.
2.Two copies of dependent travel authorization if issued.
3.Copies of secretarial approval of travel if claim concerns parents who either did not reside in your household before their travel and/or will not reside in your household after travel.
4.Copy of GTR, MTA or ticket used.
5.Hotel/motel receipts and any item of expense claimed in an amount of $75.00 or more.
6.Other attachments will be as directed.
Note: Transportation tickets purchased with a CBA must not be claimed in Item 18 as a reimbursable expense.
15d. REASON FOR STOP |
|
|
|
Authorized Delay |
- AD |
Leave En Route |
- LV |
Authorized Return |
- AR |
Mission Complete - MC |
Awaiting Transportation |
- AT |
Temporary Duty |
- TD |
Hospital Admittance |
- HA |
Voluntary Return |
- VR |
Hospital Discharge |
- HD |
|
|
ITEM 15e. LODGING COST
Enter the total cost for lodging.
ITEM 19 - DEDUCTIBLE MEALS
Meals consumed by a member/employee when furnished with or without charge incident to an official assignment by sources other than a government mess (see JFTR, par. U4125-A3g and JTR, par. C4554-B for definition of deductible meals). Meals furnished on commercial aircraft or by private individuals are not considered deductible meals.
29.REMARKS
a.INDICATE DATES ON WHICH LEAVE WAS TAKEN:
b.ALL UNUSED TICKETS (including identification of unused "e-tickets") MUST BE TURNED IN TO THE T/O OR CTO.
DD FORM 1351-2 (BACK), MAY 2011