OHRM Domestic Travel Request
Travel Order Number:____________________________________________
Fill in all blanks. If not applicable, enter N/A:
Approval: __________________________________________________________
(Include Name, Title and Signature of Recommending Official)
CAN: 8363620
Traveler Name: _______________________________Title:____________________
Social Security : ____________________
Duty Station: Building ___________ Room _______ Telephone No:_____________
Start Date: ____________________ Time: _______________________
a.m./p.m.
End Date: _____________________Time: _______________________ a.m./p.m.
Annual Leave Dates (If Applicable): ______________________________
Departure Date:_______________ Time: ________ a.m./p.m. City:_____________
Arrival Date:_________________ Time: ________ a.m./p.m. City:_____________
Departure Date:_______________ Time: ________ a.m./p.m. City:_____________
Arrival Date:_________________ Time: ________ a.m./p.m. City:_____________
Departure Date:_______________ Time: ________ a.m./p.m. City:_____________
Arrival Date:_________________ Time: ________ a.m./p.m. City:
_____________
Purpose (including name of meeting, meeting site, and dates
of meeting(s):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
| Circle Correct Code: |
Object Class Code |
| Site Visit/Monitoring Visit/Program Meeting |
|
21.11 |
|
Site Visit/Administration and Management |
|
21.13 |
|
Review/Information Meeting |
|
21.21 |
| Speech, Poster Presentation/Exhibit |
|
21.31 |
| Training: |
Internal (DHHS) |
|
21.41 |
| |
Other Government |
|
21.42 |
| |
Non-Government |
|
21.43 |
| Conference/Convention/Seminar/Symposium Attendant Only |
|
21.51 |
Registration Fee (Y/N): $______________ Due Date:_____________
Includes: Lodgings (Y/N): _____________ Meals (Y/N): _____________
Other (please specify):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Transportation
Mode of Travel (air, pov, train) _____________________
Justify Non-Contract Carrier (Space=l, Time=2, Fare=3) _____________________
Fare (GTR Blanket =1, Credit = 2) Est. Cost: ____________________
POV Est. Miles ___________________
Excess Taxis (other than to/from terminal): Est. Cost: ____________________
Car Rental, if authorized: Est. Cost: ____________________
Other (Parking, Tolls, Taxi, Subway, Bus): Est. Cost: ____________________
Telephone, Photocopying, Faxing, if authorized:
Prepared by: ___________________________________________________________
Building: ______________ Room:__________ Telephone: ______________________
Requirements for Car Rental: A memo of justification and a
comparison chart must be attached showing the estimated cost of
a taxi used to and from the hotel/airport/place of business, etc.
This paperwork must be completed before the rental car will be
considered or approved. This is a requirement for all rental car
requests.
Remarks (Justification for rental car, etc.):
Any Questions? Please Contact:
Sharon Mathsen at Building: 2, Rm. 4W13, Phone: 301-496-2424
Theresa Franklin at Building: 2, Rm. 4W25, Phone: 301-496-9222
