Leader Development / Assignment Program (LDAP) / FMWRC

FMWRC Leader Development Assignment Program (LDAP) Permanent Change of Station (PCS) Worksheet

For a full explanation of authorized entitlements please refer to the rules and regulations set forth by the DoD Travel Regulation JTR, Vol. 2, http://perdiem.hqda.pentagon.mil/perdiem/trvlregs.html

Department of State Standardized Regulations (DSSR) http://aoprals.state.gov/content.asp?content_id=231&menu_id=92.

The policy for centrally funded PCS/PDT is at http://www.armymwr.biz/ldp.htm.

Questions to be completed by the employee:

1. Are you returning from overseas (OCONUS) under an existing transportation agreement? Yes No (Circle One)

NOTE: FMWRC will pay for certain authorized PCS expenses not covered under the existing transportation agreement.

2. Are you relocation eligible candidate from a Base Realignment and Closure (BRAC) installation? Yes No (Circle One)

NOTE: FMWRC will not centrally fund PDT or PCS costs for BRAC relocation eligible candidates.

3. Are you eligible for a PDT or PCS move under another individual’s transportation agreement or military orders (i.e., retiring military, military or civilian family member)? Yes No (Circle One)

NOTE: FMWRC will pay for certain authorized PCS expenses not covered under the existing transportation agreement.

Part A – Employee’s Information

1/4 Employee’s Name: Employee’s SSN:

Current mail delivery address:

Current Home Phone: Alternate Email:

Home of Record (if other than address above):

Retirement Plan: CSRS FERS NAF (circle one)

Current Pay Plan/Series/Grade: Current Position Title:

Current Organization & Address:

Current Organization Phone Number: Current Organization Email:

New Pay Plan/Series/Grade: New Position Title:

Part A – Employee’s Information (cont’d) Gaining Organization & Address:

Departure travel date to new PDS: Reporting date to new PDS (YYYYMMDD):

Household goods pick-up address:

Mode of Transportation to new PDS: AIR POV RAIL (circle one)

Part B – Dependent (s) Information

Dependent Travel: Concurrent ______Delayed ______

Dependent Name (s) Date of Birth Relationship to Departure From To (Last, First, MI) (YYYYMMDD) Employee Travel Date (City & State) (City & State) (YYYYMMDD)

2/4 Part C – Estimated Temporary Quarters Subsistence Expense/Allowance (TQSE/TQSA) (Actual Expense)

1. Do you have permanent quarters within 50 miles of the new PDS? Yes No (Circle One)

If “Yes” is marked then TQSE/TQSA is not authorized. If no: Proceed to section entitled “Real Estate”.

2. Is a TQSE/TQSA advance requested? Yes No (Circle One) (If yes, you must submit a copy of a cancelled check so that the advance can be electronically transferred to your bank account.)

3. Will dependents require TQSE/A? Yes No N/A (Circle One)

Real Estate

1. Is this your first government duty station (do not include prior Uniformed Service)? Yes No (Circle One)

2. Are you moving to an OCONUS area? Yes No (Circle One)

3. Is this the first government move to an OCONUS area? Yes No (Circle One)

* If yes is marked on any of the questions marked above real estate expenses are NOT authorized: Proceed to “Additional Estimated Expenses”

3. Do you own a home at the current PDS (applies only to CONUS and non-foreign OCONUS)?

Yes No OCONUS/Not Applicable (Circle One)

Estimated value of home at current PDS:______

4. Are you purchasing a home at the new PDS (applies only to CONUS and non-foreign OCONUS)?

Yes No OCONUS /Not Applicable (Circle One)

Estimated value at new PDS:______

5. Will you need to terminate a lease early? Yes No (Circle One)

If yes, what is the termination fee: ______

Additional Estimated Expenses: 1. What is the approximate weight of your household goods (estimate 1000 pounds per room)? ______* Reimbursement is limited to a maximum of 18,000 lbs.

2. Will a house hunting trip be needed? Yes No (Circle One) *Reimbursement is limited to 10 days maximum.

3. Will temporary storage be needed? Yes No (Circle One) *Reimbursement is limited to 90 days.

4. Will non-temporary storage be needed (OCONUS only)? Yes No (Circle One)

5. Will a vehicle shipment be needed (OCONUS only)? Yes No (Circle One)

3/4 Employee’s Signature: Date: Part D – LDAP PCS Point of Contact

Dora Cordova FMWRC Human Resources - Comm. Phone: 703-275-5221 Leader Development DSN Phone: 235-5221 5285 Shawnee Road, Suite 610 Comm. Fax: 703-275-5228 Alexandria, VA 22312 [email protected]