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FHWA Order 1500.9, Attachment

FHWA TRAVEL POLICY SUPPLEMENT
Relocation

INTRODUCTION

EFFECTIVE DATE: This supplement shall apply to all transfers that occur on or after April 1, 1998.

CONCEPT OF REGULATIONS. The following Federal Highway Administration (FHWA) policy represents a supplement to the Federal Travel Regulation (FTR) (41 CFR 302) and DOT Travel Guiding Principles (DTGP). The FHWA Travel Policy (FTP) Supplement, on salmon-colored paper, shall be filed behind each corresponding Chapter and Part of the FTR and DTGP.

To understand the entire body of regulations and policy surrounding allowable relocation entitlements, you should first read the FTR, then, if applicable, the DTGP corresponding policy, and if applicable, the FTP Supplement. Where no corresponding FTR and/or DTGP reference is found to the FTP Supplement paragraph, this means it is a FHWA reference only. Internet web links are being established to ensure this information is available to all employees.

All of the aforementioned policy references apply to all FHWA employees.

DELEGATION OF AUTHORITY. The Associate Administrator for Administration has the authority to supplement the FTR and DTGP as appropriate. Reference to "agency head" in the FTR and the DTGP refers to the FHWA Administrator. The FTP will identify certain travel approvals which have been redelegated below the Administrator level, and those which may be further delegated in accordance with the FHWA Order 1100.1, Delegations of Authority.

FHWA relocation policy will be issued on an as needed basis for the purpose of providing internal FHWA policy guidance and processing procedures.

OTHER SUPPLEMENTING MATERIALS. Publications cited in the FTR or DTGP should be used as appropriate.

CONTACTS. The Relocation Allowances Team, within the Office of Budget and Finance, is the relocating employee's primary contact for first duty or permanent change-of-station policy and guidance.

CHANGES. Additions to the FTP Supplement will be denoted by date issued. Changes will be denoted by vertical lines placed on the left margin.

PART 302-1--APPLICABILITY, GENERAL RULES,
AND ELIGIBILITY CONDITIONS

FTR PART 302-1--APPLICABILITY, GENERAL RULES, AND ELIGIBILITY CONDITIONS

Subpart A--New Appointees and Transferred Employees

§302-1.3 General Provisions

(a) Travel Covered--(1) Mandatory Coverage.

(i) Within FHWA, relocation benefits shall not be payable where the relocation is clearly for the convenience of the employee. Such instances shall include, but not be limited to:

(1) A position created based on an employee request.

(2) An employee being permitted to work in a remote location for their convenience.

On a case-by-case basis, this prohibition may be waived if it is determined that the relocation will provide significant benefit to FHWA. Authority to approve relocation benefits in these instances shall lie with the Associate Administrator for Administration, HAD-1.

Within FHWA, transferees will be provided with a minimum of 90 days to report to the new duty station after notification of transfer. Exceptions to this provision shall be in accordance with FTR 302-1.3(b)(1-3).

(i) In those instances where operational necessity requires that a transferee report in less than ninety days, the gaining office may issue a temporary duty assignment (TDY) to the transferee. The period of TDY would be the accelerated reporting date to the end of the ninety day period. Funding for the TDY would be from the gaining office's general travel funds. In these instances, a househunting trip shall not be authorized.

302-1.5 Service Agreements

(a) Within FHWA, all transferees shall be required to sign Form FHWA-2, CONTINUED SERVICE AGREEMENT FOR CHANGE OF OFFICIAL DUTY STATION IN CONTINENTAL UNITED STATES (See Exhibit 3). This form must be submitted prior to receiving a travel authorization and/or reimbursement for any relocation expenses.

PART 302-1--APPLICABILITY, GENERAL RULES, AND ELIGIBILITY CONDITIONS

Subpart A--New Appointees and Transferred Employees

§302-1.3 General Provisions

     (a) Travel Covered--(1) Mandatory Coverage.

     (i) Within FHWA, relocation benefits shall not be payable where the relocation is clearly for the convenience of the employee. Such instances shall include, but not be limited to:

On a case-by-case basis, this prohibition may be waived if it is determined that the relocation will provide significant benefit to FHWA. Authority to approve relocation benefits in these instances shall lie with the Director of Administration, HAD-1.

     (b) Within FHWA, transferees will be provided with a minimum of 90 days to report to the new duty station after notification of transfer. Exceptions to this provision shall be in accordance with FTR 302-1.3(b)(1-3).

     (i) In those instances where operational necessity requires that a transferee report in less than 90 days, the gaining office may issue a temporary duty assignment (TDY) to the transferee. The period of TDY would be the accelerated reporting date to the end of the 90 day period. Funding for the TDY would be from the gaining office's general travel funds. In these instances, a househunting trip shall not be authorized.

§302-1.5 Service Agreements

     (a) Within FHWA, all transferees shall be required to sign Form FHWA-2, Continued Service Agreement for Change of Official Duty Station in Continental United States (See Exhibit 3). This form must be submitted prior to receiving a travel authorization and/or reimbursement for any relocation expenses.

§302-1.12 Overseas Assignment and Return

     (c) Actual place of residence designation.

     (1) Designation by employee. Where the Director, Office of Human Resources, or his designee, has determined that an entitlement to home leave exists, the employee shall designate, in writing, the place of actual residence, or home of record. The home of record must be:

     (i) the place where the employee actually resided at time of selection, or

     (ii) a place where the employee maintains close familial or other friendly relationships, or

     (iii) any other place if justified by the employee and approved by FHWA (see FTP 302-1.12(c)(2) below).

     (2) Determination by agency official. Within FHWA, determination of the home of record shall be made by the Director, Office of Human Resources, or his designee, with concurrence from the Director, Office of Budget and Finance, orhis designee.

§302-1.13 Overseas Tour Renewal Agreement Travel

     (a) Eligibility. Within FHWA, the purpose of home leave shall be to provide employees and their families an extended period of time in which to become reacquainted with their native culture after completion of a tour of duty in a foreign or non-foreign post of duty (except as provided in FTP 302-1.13(a)(3) ) and before commencement of a subsequent tour in a foreign or non-foreign post of duty. Home leave shall not be granted solely for vacation purposes. Where the Director, Office of Human Resources, or his designee, has determined that home leave shall be used as a recruitment and/or retention tool, a separate determination shall be made to ensure that the selectee meets the eligibility criteria contained herein. Factors to be considered should include, but not be limited to:

If the record does not support a finding that the granting of home leave will provide an opportunity for the employee and/or his immediate family to become reacquainted with their native culture, no entitlement to home leave shall exist.

     (3) Employees assigned, appointed, or transferred to a post of duty in Alaska or Hawaii after September 8, 1982. Unless determined by the Director, Office of Human Resources, or his designee, to be a recruitment and retention tool, FHWA will not grant home leave in connection with a change of station to Alaska or Hawaii. The decision to grant home leave shall be made on a case-by-case basis and must be specifically included in the written job offer. This provision shall apply to transfers that occur on or after February 1, 1999.

§302-1.16 Procedural Requirements-This section has no corresponding FTR reference.

     (a) Service Agreement. Where eligibility for home leave is determined to exist, the employee shall sign Form FHWA-127, Standard Conditions of Employment For U.S. Citizens Stationed At Overseas Posts, and shall designate the home of record as required in FTP 302-1.12. This form shall be forwarded to the Director, Office of Human Resources, or his designee, for determination as provided in FTP 302-1.12(c)(2) and shall become part of the employee's official record.

     (b) Reimbursement. The employee shall be allowed travel and transportation allowances subject to the provisions of FTR 302-1.13(b).

PART 302-1--TEMPORARY CHANGE-OF-STATION

FTR PART 302-1--APPLICABILITY, GENERAL RULES, AND ELIGIBILITY CONDITIONS

Subpart C--Employee's Temporary Change of Station (TCS)

§302-1.204 Must my agency authorize a TCS when I am directed to perform a long-term assignment at a temporary official station?

(a) Within FHWA, the TCS will be implemented as a possible alternative to long-term assignments with a duration of at least 12, but no more than, 30 months.

§302-1.210 Is there any required minimum distance between an official station and a long-term assignment location that must be met for me to qualify for a TCS?

(a) Within FHWA, a TCS will not be authorized if the minimum distance requirements contained in FTR 302-1.3(a)(1) are not met.

§302-1.219 Will my agency pay for property management services when I am authorized a TCS?

(a) No. See 302-15.5(a) of the FTP Supplement.

Subpart D--Agency Responsibilities for Temporary Change-of-Station

§302-1.301 What governing policies must we establish for our TCS program?

(a) See 302-1.204(a) and 302-1.210 of the FTP Supplement.

(b) The authority to approve a TCS shall lie with the Associate Administrator for Administration, HAD-1, and will be considered on a case-by-case basis. Factors to be considered shall include but not be limited to:

(1) Possible tax consequences when a TDY assignment exceeds one year.

(2) Cost considerations (e.g., cost of relocation to and from the temporary station as opposed to payment of a reduced per diem allowance as provided in FTR 301-7.12).

(3) Morale factors.

PART 302-4--ALLOWANCE FOR HOUSEHUNTING TRIP EXPENSES

FTR PART 302-4--ALLOWANCE FOR HOUSEHUNTING TRIP EXPENSES

Subpart A--Employee's Allowance for Househunting Trip Expenses

§302-4.2 What is the purpose of the househunting trip expenses allowance?

(a) See §302-5.104(b) of the FTP Supplement.

§302-4.13 What methods may my agency use to reimburse me for househunting trip expenses?

(a) See §302-4.101(c) of the FTP Supplement.

Subpart B--Agency Responsibilities

§302-4.101 What governing policies must we establish for the househunting trip expenses allowance?

(a) A househunting trip shall not be authorized in those instances where a transferee is, or was recently, in a long-term TDY status as described in Subpart A, §302-1.3(b)(i) of the FTP.

(c) Within FHWA, each eligible employee shall be offered the following reimbursement methods:

(1) A per diem allowance as described in FTR Subpart A, §302-4.13(a).

(2) Fixed amount as provided in FTR Subpart A, FTR §302-4.13(b).

(I) Transferees shall be required to specify, in writing, their preferred reimbursement method. Once an election has been made, the FHWA will consider the choice "final." The transferee will specify his election on the Permanent Change of Station Questionnaire (See Exhibit 1), which will become part of the official file.

§302-4.103 What factors must we consider in determining whether to offer an employee the fixed amount househunting trip subsistence expenses reimbursement option?

(c) See §302-4.101(c) of FTP Supplement.

PART 302-5--ALLOWANCE FOR TEMPORARY QUARTERS
SUBSISTENCE EXPENSES (TQSE)

FTR PART 302-5--ALLOWANCE FOR TEMPORARY QUARTERS SUBSISTENCE EXPENSES (TQSE)

Subpart A--General Rules

§302-5.11 What methods may my agency use to reimburse me for TQSE?

(a) Within FHWA, each eligible transferee shall be offered the following reimbursement methods:

(1) Actual expense as provided in Federal Travel Regulation (FTR) Subpart B, §302-5.100.

(2) Fixed amount as provided in FTR Subpart C, §302-5.201.

(b) Transferees shall be required to specify, in writing, their preferred reimbursement method. Once an election has been made, the FHWA will consider the choice "final." The transferee will specify his election on the Permanent Change of Station Questionnaire (See Exhibit 1), which will become part of the official file.

Subpart B--Actual TQSE Method of Reimbursement

§302-5.104 How long may I be authorized to claim actual TQSE reimbursement?

(a) Within FHWA, the initial period of temporary quarters for each eligible transferee may not exceed 30 days, subject to the limitation in (b). If FHWA determines that a "compelling reason" exists, the TQSE allowance may be extended for an additional period. In no case shall the authorized period of reimbursement exceed 120 days. Extensions may only be allowed in connection with the actual expense method.

(b) The authorized period of temporary quarters shall be reduced by the number of days used in connection with a househunting trip. This reduction shall not apply when an employee elects to receive a fixed-amount in lieu of the actual expense reimbursement method.

§302-5.105 What is a "compelling reason" warranting extension of my authorized period for claiming actual TQSE reimbursement?

(a) Within FHWA, additional time in TQSE may be considered in the following circumstances:

(1) Delivery of household goods to the new residence is delayed due to a strike, customs clearance, hazardous weather, fire, flood or other act of God, or similar event.

(2) The employee can not occupy a new residence because of unanticipated problems (e.g., delay in settlement on an existing residence, unanticipated short-term delay-less than 30 days in settlement of new construction).

(3) The employee is unable to locate a permanent residence which is adequate for their family's needs because of housing conditions at the new official station (not finding a residence suited to personal taste is not acceptable).

(4) Sudden illness, injury or death of employee or immediate family member.

(5) Other reasons acceptable to the agency.

(b) The temporary quarters allowance shall be limited to 30 days for the following reasons:

(1) Construction of a residence except as noted in Subpart B, §302-5.105(a)(2) of the FTP.

(2) Employee has had adequate opportunity to complete arrangements for permanent housing prior to transfer (as a result of extended temporary duty assignment, etc).

(c) All requests for an extension shall be submitted in writing to:

Chief, Finance Division, HFS-20
400 Seventh St., S.W.
Washington, DC 20590

(d) Each extension request shall be evaluated on a case-by-case basis. Factors to be considered shall be in accordance with (a) and (b) of this section and shall include, but not be limited to, documented expressions of intent, such as number and type of homes viewed, construction agreements with delivery dates, etc.

FTR PART 302-10--ALLOWANCES FOR TRANSPORTATION AND EMERGENCY STORAGE OF A PRIVATELY OWNED VEHICLE

Subpart A--General Rules

§302-10.6 What POV transportation and emergency storage may my agency authorize at Government expense?

(c) See Subpart D, §302.10.301 of FTP Supplement.

Subpart D--Transportation of a POV Wholly Within the
Continental United States (CONUS)

§302-10.301 Under what conditions may my agency authorize transportation of my POV wholly within CONUS?

(a) Within FHWA, transportation of a POV wholly within CONUS shall be authorized only in those cases where an employee or a member of his immediate family have a medical or physical condition that makes vehicular travel difficult or inadvisable.

Subpart F--Agency Responsibilities

§302-10.502 What governing policies must we establish for the allowances for transportation and emergency storage of a POV?

(e) The authority to authorize shipment of a POV lies with the Associate Administrator for Administration, HAD-1. Each request for exception shall be submitted in writing and must be accompanied by a physician's medical certificate.

DTGP PART 302-12--USE OF A RELOCATION SERVICES COMPANY

FTR PART 302-12--USE OF A RELOCATION SERVICES COMPANY

Subpart A--Agency's Use of a Relocation Services Company

§302-12.7 What policies must we establish when offering our employees the services of a relocation services company?

(a) Within FHWA, each eligible transferee shall be permitted to enter into the Guaranteed Home Sale Program within seven days of notification of transfer. However, transferees shall market their homes with an independent realtor for a minimum of 60days before accepting an offer from the relocation services company.

(b) Each eligible transferee shall be authorized the relocation services listed in §302-12.7(c).

(c) The FHWA, through a third-party contractor, shall offer the following relocation services to all eligible transferees:

(1) Counseling services in connection with the shipment and storage off household goods.

(2) Sale of an eligible residence through a Guaranteed Home Sale Program.

(d) Each transferee shall complete the FHWA RELOCATION SERVICES AUTHORIZATION FORM (See Exhibit 2) before any relocation services may occur.

Subpart B--Employee's Use of a Relocation Services Company

§302-12.102 Under what conditions may I use a relocation services company?

(c) See Subpart A, §302-12.7(a) of the FTP Supplement.

PART 302-14--HOME MARKETING INCENTIVE PAYMENTS

FTR PART 302-14--HOME MARKETING INCENTIVE PAYMENTS

Subpart B--Agency Responsibilities

§302-14.102 What factors should we consider in determining whether to establish a home marketing incentive payment program?

(a) The FHWA will delay consideration of the Home Market Incentive for a period of one year, pending further review and analysis.

PART 302-15--ALLOWANCE FOR PROPERTY MANAGEMENT SERVICES

FTR PART 302-15--ALLOWANCE FOR PROPERTY MANAGEMENT SERVICES

Subpart A--General Rules for the Employee

§302-15.5 In what situations may my agency authorize payment for property management services?

(a) As FHWA does not maintain foreign or overseas offices, no policy will be issued until such time as they are established.

(b) See §302-15.5(a) of the FTP Supplement.

Subpart B--Payment for Property Management Services for Employees Transferred to a Foreign Area Post of Duty

§302-15.100 Am I eligible for payment for property management services under this subpart?

(a) See §302-15.5(a) of the FTP Supplement.

§302-15.101 Will my agency pay for property management services when I transfer to a foreign area post of duty?

(c) See §302-15.5(a) of the FTP Supplement.

Subpart C--Payment for Property Management Services for Employees Transferred to a Nonforeign Area From a Foreign Area

§302-15.200 Am I eligible for payment for property management services under this subpart?

(a) See 302-15.5(a) of the FTP Supplement.

§302-15.201 Under what circumstances will my agency authorize payment under this subpart?

(c) See 302-15.5(a) of the FTP Supplement.

Subpart D--Agency Responsibilities

302-15.300 What governing policies must we establish for the allowance for property management services?

(a) See 302-15.5(a) of the FTP Supplement.


PERMANENT CHANGE-OF-STATION QUESTIONNAIRE
FIRST-DUTY STATION, SES LAST MOVE HOME, RETURN TO CONUS

Name: _______________________________________ SSN: _____________________

Property Address: _________________________________________________________

Mailing Address (if different): _________________________________________________

Home Telephone: _____________________Work Telephone: _______________________

Retirement System (please check one): FERS _____ CSRS _____

Supervisor Name (new duty station): ____________________________________________

1. Origin (City and State): ____________________________________________________

2. New Official Station (City and State):__________________________________________

3. Effective Date of Transfer (Payroll Transfer): ____________________________________

4. Reporting Date:__________________________________________________________

5. Marital Status: Single _______ Married _______

6. Dependents (Names (including spouse), Relationship and Children's Date of Birth):
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

7. Enroute Travel (travel to new duty station):

Do you and your family plan to travel together; or do you anticipate separate (travel at a later date) dependent travel (check one)?

Employee Only ____ via (mode of transportation)________________________
Together ____via (mode of transportation)________________________
Separate ____via (mode of transportation) ________________________

If separate, state reason(s) below.
___________________________________________________________________________ ___________________________________________________________________________

8. Shipment of Household Goods and Personal Effects (Check only one):

GBL Method: ______ (Household goods shipped by a GSA authorized carrier.)

Mobile Home: ______ (Shipment (transportation) of mobile home is authorized in lieu of shipment and storage of household goods.)

Actual Expenses: _____ (Do-it-yourself method not to exceed the cost of the lowest GBL carrier. Weight certificates are required.)

Commuted Rate: _____ (Authorized only when the weight is 2,000 lbs. or less. Weight certificates are required.) Approximate number of pounds to be shipped and stored (18,000 Lbs. Max. - 1000 Lbs/Room): __________________________

9. Comments: ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

PRIVACY ACT NOTICE

Under the provisions of Chapter 57, title 5 U.S.C., the information on this questionnaire is required to complete your travel order and approve your application for advance of travel funds. Failure to provide the information may preclude the issuance of your travel order.

Return completed PCS Questionnaire, Continued Service Agreement Relocation Services Authorization Form, and the SF-1038, Advance of Funds Application to: FHWA, HFS-24, Room 4306, 400 7th St., S.W., Washington, D.C. 20590; OR FAX to (202) 366-3312, ATTN: PCS Team.

Signature: __________________________________________ Date: ___________________ Exhibit 1A




PERMANENT CHANGE-OF-STATION QUESTIONNAIRE

Name: ________________________________________ SSN: _________________________

Property Address: ______________________________________________________________

Mailing Address (if different): _____________________________________________________

Home Telephone: _______________________Work Telephone: _________________________

Retirement System (please check one): CSRS ______ FERS _____ CSRS Offset _____

Supervisor Name (new duty station): ________________________________________________

1. Old Duty Station: ____________________________________________________________

2. New Official Station: __________________________________________________________

3. Effective Date of Transfer (Payroll Transfer): ______________________________________

4. Reporting Date: __________________ Annual Leave Enroute: ________________________

(Consider approximate travel time) (Indicate Dates)

5. Marital Status: Single _______ Married _______

6. Dependents (Names (including spouse), Relationship and Children's Date of Birth):

___________________________________________________________________________

___________________________________________________________________________ ___________________________________________________________________________

___________________________________________________________________________

7. Househunting Trip (Employee and Spouse Only): Yes ____ No ____

(Note: The mode of travel selected should maximize your time for househunting and minimize travel time.)

Reimbursement Method (select one): Per Diem: ________ Fixed Amount: _______

Mode of Travel (check one): Common Carrier/Rental Car ______ POV _______

Total Est. Cost: Airfare $__________ Rental Car $_________ No. of Days: ___________

Estimated Dates: ____________________________________________________________

8. Enroute Travel (travel to new duty station):

Together ________Mode of Travel_______________

Separate ________ Mode of Travel_______________ (State reason for separate travel below)

Single___________Mode of Travel_______________

___________________________________________________________________________

___________________________________________________________________________

Page 2

9. Temporary Quarters: Yes ________ No ________

Reimbursement Method (select one): Fixed Amount: ______ Actual Subsistence: ______

10. Shipment of Household Goods and Personal Effects (select one):

Approximate number of pounds to be shipped and stored? : __________________________

(18,000 Lbs. Maximum - 1,000 Lbs.. Per Room)

GBL Method: _______ (Household goods shipped by Government)

Mobile Home: ______ (Shipment (transportation) of mobile home is authorized in lieu of

shipment and storage of household goods)

Actual Expenses: ____ (Do-it-yourself method not to exceed the cost of the lowest GBL carrier. Weight certificates are required or commercial carriers bill.)

Commuted Rate:_____ (Authorized only when the weight is 2,000 lbs., or less. Weight

certificates are required.)

11. Real Estate:

Do you have a home to sell? Yes ____ No ____ Est.Selling Price $________________

Do you elect to use Relocation Services? Yes ____ No ____

(Note: Mobile Homes and Co-op's are not eligibile for this program.)

Will you have lease breaking expenses? Yes _____ No _____ Amount: $_______________

Will you purchase a new home? Yes ____ No ____ Est. Purchase Price $______________

12. Miscellaneous Expenses: Standard Allowance _________ Itemized Expenses: ________

($700/$350) (Receipts)

13. Comments:

_________________________________________________________________________

_________________________________________________________________________

PRIVACY ACT NOTICE

Under the provisions of Chapter 57, title 5 U.S.C., the information on this questionnaire is required to complete your travel order and approve your application for advance of travel funds. Failure to provide the information may preclude the issuance of your travel order.

Return completed PCS Questionnaire, Continued Service Agreement Relocation Services Authorization Form, and the SF-1038, Advance of Funds Application to:

PCS Team Member: __________________ FHWA, HFS-24, Room 4306, 400 7th St., S.W., Washington, D.C. 20590

Signature: __________________________________________ Date: ___________________ Exhibit 1B





 

FHWA RELOCATION SERVICES AUTHORIZATION FORM

1. EMPLOYEE NAME (Last, First, Middle):
2. TRAVEL AUTHORIZATION NUMBER:
3. REPORTING DATE (New Duty Station):
4. RELOCATING FROM (Old Duty Station, City, State):
5. RELOCATING TO (New Duty Station, City, State):
6. ( ) I wish to use the Guaranteed Homesale Services , but wish to DEFER the services approximately ___________ months, but not later than two (2) years from reporting date (expiration of entitlement period ).
7. HOME ADDRESS (Old residence, Street, City, State and Zip Code):

 8. MARITAL STATUS: ( ) Single ( ) Married ( ) Divorced ( ) Separated

Spouse Name

9. TELEPHONE NUMBERS: (Include area codes)

Old Work No.: _________________ New Work No.: _________________ Home No.: _________________`

10. SERVICES REQUESTED: (Check all appropriate boxes)

( ) Guaranteed Home Sale and Marketing Assistance ( ) Mortgage Counseling

( ) Homefinding ( ) Spouse Counseling (Expense to the employee)

( ) HomeExpress (Shipment of HHG) Est. Weight: _________ Distance: _______ SIT: 90 Days

IMPORTANT: To be eligible for Guaranteed Home Purchase and Marketing Assistance, an employee must reside in and commute daily to and from the home to his/her official duty station on the date the employee is notified of the permanent change of station. An employee who maintains a room at a duty location and returns to his/her home on weekends is not eligible to use the Guaranteed Home Purchase or the Marketing Assistance and will be liable for repayment of any costs incurred. Also, title to the residence (home) must be in the name of the employee and/or a member of the employee's immediate family. A separated spouse is not a member of the employee's immediate family. If you have any questions regarding your eligibility, please contact your Relocation Services Coordinator prior to completing this form.
11. NAME(S) SHOWN ON TITLE TO RESIDENCE:
12. RELATIONSHIP OF CO-OWNER(S) TO EMPLOYEE:
13. NUMBER OF MILES FROM OLD RESIDENCE TO OLD DUTY STATION:
14. I request (and defer as indicated above) relocation services.

__________________________________________ _______________________

Signature Date

PRIVACY ACT NOTICE

The information on this from is required to provide you with relocation services in connection with your official change of station pursuant to Chapter 57, Title 5 U.S.C. Information hereon may be disclosed to civil agencies under certain circumstances. Failure to provide the information may preclude or delay your official change of station.

AGENCY USE ONLY

15. AUTHORIZED BY: ____________________________________________________________ DATE: _____________________

Relocation Services Coordinator

16. ACCOUNTING CLASSIFICATION: ______________________________________________________________________________

17. DELIVERY ORDER NO: (Homesale Service Only)____________________________________________________________________

18: ACCOUNTING OFFICE: Federal Highway Administration, HFS-24, Room 4306, 400 7th Street, S.W., Washington, D.C. 20590

Exhibit2




U.S. DEPARTMENT OF TRANSPORTATION
Federal Highway Administration
CONTINUED SERVICE AGREEMENT
FOR CHANGE OF OFFICIAL DUTY STATION
IN CONTINENTAL UNITED STATES


INSTRUCTIONS

Pursuant to 5 U.S.C. 5724, execution of this agreement is required in connection with each permanent change of station of an employee between and to official duty stations within the continental United States (excluding Alaska) as a condition prerequisite to the payment of the expenses and relocation allowances authorized by law and regulations.

DOT F 1500.4, Travel Order, authorizing travel in connection with the change of official duty stations to which this agreement applies, will also authorize such other expenses and allowances as are deemed appropriate to the particular circumstances, and should be annotated to show the date on which this agreement was executed.

Prepared in duplicate. The original copy shall be given to the employee, and one signed copy shall be placed in the employee's personnel folder.


AGREEMENT

In consideration of the payment by the government of the costs of such travel, transportation, storage, and other relocation allowances as may be authorized in an official travel order issued in connection with the change of official duty station identified below, I agree to remain in the employment of the United States government for twelve months following the effective date of such changes unless separated for reasons beyond my control and acceptable to the Department or agency in which I am then employed.

I understand that in case of violation of this agreement, any moneys expended by the United States for such travel, transportation, storage, or other relocation allowances shall be recoverable from me as a debt due the United States.

(The effective date of change of official duty station is the date of entrance on duty at the new official station.)


PERMANENT CHANGE OF STATION

From:

Official Duty Station From Which Transferred


To:

Official Duty Station To Which Transferred.

NAME OF EMPLOYEE


NAME OF WITNESS
SIGNATURE OF EMPLOYEE    DATE


SIGNATURE OF WITNESS    DATE

Form FHWA-2

(REV. 5-77) Previous Editions Are Obsolete EXHIBIT 3 Exhibit 3



Page last modified on October 19, 2015
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