Please write legibly


1.  Employee's Name & SSN:________________________________________________

 2.  Retirement Code:  (Code found in Blk 30 of most recent SF-50)__________________

3.  New Position, Series, & Grade:  ___________________________________________

4.  Present Duty Station, Address, & Location:  _________________________________


5.  New Duty Station, Address, & Location:  ___________________________________


6.  Employee's Present Home Address to include County


7.  Home & Work Phone Numbers & FAX Number (Comm & DSN), & E-mail:  ______


 8.  Dependent Travel Data:   Concurrent________       Delayed_________

     Names, Gender of Dependents, Relationship, & Dates of Birth:





 9.  Selling a Home at PDS (Entitled when assigned to a foreign area PDS) (First Duty Station Employees Not Entitled):  ____________________________________________

                                                          (Estimated Selling Price)

10.  Purchasing a Home at New PDS: (If applicable)  (First Duty Station Employees Not Entitled):                                                                 _____________________________

                                                                                            (Estimated Purchase Price)

 11.  House Hunting Trip Authorized:    Yes _______                No________

(This is not an entitlement, must be authorized by gaining organization & funds must be available) (First Duty Station Employees Not Entitled):

 Mode of Transportation:  ________________________________________________

 Will Spouse Accompany Employee:  ______________________________________

 How Many Days Authorized (NTE 10 Days):  _______________________________

 Will HHT be in Conjunction with PCS Move or Separate Trip:__________________


 Rental Car Requested:  Yes __________                No _______________

 Days - Number of days utilized for house hunting trip will be deducted from number of days for TQSE.  Deduction of days will be accomplished by Finance when settlement voucher is submitted.

 Duty Status -IAW JTR Volume II, C4107 R - Status while on House Hunting Trip (HHT) - "An employee is in a duty status at no charge to leave while performing house hunting travel during the authorized period of absence."

 12.  POV Shipment:  Yes ________      No _________    If yes, please provide the following information:  (JTR 1100- Authorization & Approval Required)


    Make: ______________________

    Mdl:  _______________________



    Name of Insurance Company & Policy #:____________________________________

 13.  Mode of Transportation for Employee & Dependents to PDS:  __________________


14.  Official Release Date:  _________________________________________________ 

15.  Date Transportation Agreement Signed:  ___________________________________


 16.  Authorization for Unaccompanied Baggage Needed?  Yes_______    No______      

Weight Allowance - Employee & Adult Dependents:  350 lbs each

                                 Dependents less than 12 years old:  175 lbs each

 Shipment of unaccompanied baggage by expedited mode to, from, & between overseas station - Total aggregated amount shipped by air may not exceed 1000 lbs net weight.