Travel voucher or subvoucher




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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.

(Specify ASB Meeting / Study       )



1. PAYMENT

SPLIT DISBURSEMENT: The Paying Office will pay directly to the Government Travel Charge Card (GTCC) contractor the portion of your remimbursement representing travel charges for transportation, lodging and rental car if you are a civlian 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.
 Pay the following amount of this reimbursement directly to the Government Travel Charge Card Contractor $0.00



Electronic Fund transfer (EFT)



Payment by Check

2. NAME (Last, First, Middle Initial)

     


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 & AREA CODE

     


8. TRAVEL ORDER NUMBER
     

9. PREVIOUS GOVERNMENT PAYMENTS/ADVANCES

     



a. D.O. VOUCHER NUMBER


11. ORGANIZATION AND STATION

     


b. SUBVOUCHER NUMBER


12. DEPENDENTS (X and complete as applicable)

13. DEPENDENTS ADRESSES ON RECEIPT OF ORDERS (Include Zip Code)

     


c. PAID BY



ACCOMPANIED



UNACCOMPANIED

a. Name (Last, First, Middle Initial)

b. RELATIONSHIP

c. DATE OF BIRTH OR MARRIAGE

     

     

     

     

     

     

     

     

     

14. HAVE HOUSEHOLD GOODS BEEN SHIPPED?

(X one)

d. COMPUTATIONS

     

     

     



YES



NO (Explain in Remarks)




15. ITINERARY




a. DATE

    

b. PLACE (Home, Office, Base, Activity, City andState;

City and Country, etc.)

c.

MEANS/ MODE OF TRAVEL



d.

REASON FOR

STOP


e.

LODGING COST



f.

POC 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 TDY 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 Expense

$

     

     

     

     



MORE THAN 12 HOURS BUT 24 HOURS OR LESS

(7) TOTAL

$

     

     

     

     

(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

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

20.a. CLAIMANT SIGNATURE

b. DATE

c. SUPERVISOR SIGNATURE

d. DATE

21.a. APPROVING OFFICER SIGNATURE

b. DATE

22. ACCOUNTING CLASSIFICATION

23. COLLECTION DATA

24. COMPUTED BY

25. AUDITED BY

26. TRAVEL ORDER/ AUTHORIZATION POSTED BY

27. RECEIVED (Payee Signature and Date or Check No.)

28. AMOUNT PAID

DD FORM 1351-2, JUL 2004


PREVIOUS EDITIONS ARE OBSOLETE.

Exception to SF 1012 approved by

GSA/IRMS 12-91



PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 5701, 37 U.S.C. Sections 404-427, 5 U.S.C. Section 301, DoDFMR 7000.14-R, Vol. 9, and E.O. 9397.
PRINCIPAL PURPOSE(S): This record is used for reviewing, approving, accounting and disbursing money for claims submitted by Department of Defense (DoD) travelers for official Government travel. The Social Security Number (SSN) is used to maintain a numerical identification system for and retrieving individual claims.
ROUTINE USE(S): Disclosures are permitted under 5 U.S.C. 552a(b), Privacy Act of 1974, as amended. In addition, information may be disclosed to the Internal Revenue Service for travel allowances, which are subject to Federal income taxes, and for any DoD “Blanket Routine Use” as published in the Federal Register.

DISCLOSURE: Voluntary; however, failure to furnish information requested may result in total or partial denial of amount claimed.


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 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 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.



ITEM 15 - ITINERARY - SYMBOLS
15c. MEANS/MODE OF TRAVEL (Use two letters)


GTR/TKT - T

Government Transportation - G

Commercial Transportation

(Own expense) - C

Privately Owned

Conveyance (POC) - P
15d. REASON FOR STOP
Authorized Delay - AD

Authorized Return - AR

Awaiting Transportation - AT

Hospital Admittance - HA

Hospital Discharge - HD



Automobile - A

Motorcycle - M

Bus - B

Plane - P



Rail - R

Vessel - V


Leave En Route - LV

Mission Complete - MC

Temporary Duty - TD

Voluntary Return - VR


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 TAKEN:                  


b. ALL UNUSED TICKETS (including identification of unused “e-tickets”) MUST BE TURNED IN TO THE T/O OR CTO.
(1) I hereby assign to the U.S. any rights I may have against other parties in consideration with any reimbursable carrier transportation charges described herein.

signature date


(2) AO statement on blk 29 of DD 1351-2 that "Reimbursement of personally procured transportation not to exceed GTR rate is authorized, despite traveler's deviation from CTO-mandatory-use policy"
signature date

(3) CTO Office did not charge this ticket to the CBA account.



signature date

DD FORM 1351-2 (BACK), JUL 2004


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