<p> FMWRC Leader Development Assignment Program (LDAP) Permanent Change of Station (PCS) Worksheet</p><p>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 </p><p>Department of State Standardized Regulations (DSSR) http://aoprals.state.gov/content.asp?content_id=231&menu_id=92. </p><p>The policy for centrally funded PCS/PDT is at http://www.armymwr.biz/ldp.htm. </p><p>Questions to be completed by the employee: </p><p>1. Are you returning from overseas (OCONUS) under an existing transportation agreement? Yes No (Circle One) </p><p>NOTE: FMWRC will pay for certain authorized PCS expenses not covered under the existing transportation agreement. </p><p>2. Are you relocation eligible candidate from a Base Realignment and Closure (BRAC) installation? Yes No (Circle One) </p><p>NOTE: FMWRC will not centrally fund PDT or PCS costs for BRAC relocation eligible candidates. </p><p>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) </p><p>NOTE: FMWRC will pay for certain authorized PCS expenses not covered under the existing transportation agreement. </p><p>Part A – Employee’s Information</p><p>1/4 Employee’s Name: Employee’s SSN:</p><p>Current mail delivery address:</p><p>Current Home Phone: Alternate Email:</p><p>Home of Record (if other than address above):</p><p>Retirement Plan: CSRS FERS NAF (circle one)</p><p>Current Pay Plan/Series/Grade: Current Position Title:</p><p>Current Organization & Address:</p><p>Current Organization Phone Number: Current Organization Email:</p><p>New Pay Plan/Series/Grade: New Position Title:</p><p>Part A – Employee’s Information (cont’d) Gaining Organization & Address:</p><p>Departure travel date to new PDS: Reporting date to new PDS (YYYYMMDD):</p><p>Household goods pick-up address:</p><p>Mode of Transportation to new PDS: AIR POV RAIL (circle one)</p><p>Part B – Dependent (s) Information</p><p>Dependent Travel: Concurrent ______Delayed ______</p><p>Dependent Name (s) Date of Birth Relationship to Departure From To (Last, First, MI) (YYYYMMDD) Employee Travel Date (City & State) (City & State) (YYYYMMDD)</p><p>2/4 Part C – Estimated Temporary Quarters Subsistence Expense/Allowance (TQSE/TQSA) (Actual Expense)</p><p>1. Do you have permanent quarters within 50 miles of the new PDS? Yes No (Circle One) </p><p>If “Yes” is marked then TQSE/TQSA is not authorized. If no: Proceed to section entitled “Real Estate”. </p><p>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.)</p><p>3. Will dependents require TQSE/A? Yes No N/A (Circle One)</p><p>Real Estate</p><p>1. Is this your first government duty station (do not include prior Uniformed Service)? Yes No (Circle One) </p><p>2. Are you moving to an OCONUS area? Yes No (Circle One) </p><p>3. Is this the first government move to an OCONUS area? Yes No (Circle One) </p><p>* If yes is marked on any of the questions marked above real estate expenses are NOT authorized: Proceed to “Additional Estimated Expenses”</p><p>3. Do you own a home at the current PDS (applies only to CONUS and non-foreign OCONUS)?</p><p>Yes No OCONUS/Not Applicable (Circle One) </p><p>Estimated value of home at current PDS:______</p><p>4. Are you purchasing a home at the new PDS (applies only to CONUS and non-foreign OCONUS)? </p><p>Yes No OCONUS /Not Applicable (Circle One) </p><p>Estimated value at new PDS:______</p><p>5. Will you need to terminate a lease early? Yes No (Circle One) </p><p>If yes, what is the termination fee: ______</p><p>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.</p><p>2. Will a house hunting trip be needed? Yes No (Circle One) *Reimbursement is limited to 10 days maximum.</p><p>3. Will temporary storage be needed? Yes No (Circle One) *Reimbursement is limited to 90 days. </p><p>4. Will non-temporary storage be needed (OCONUS only)? Yes No (Circle One) </p><p>5. Will a vehicle shipment be needed (OCONUS only)? Yes No (Circle One) </p><p>3/4 Employee’s Signature: Date: Part D – LDAP PCS Point of Contact </p><p>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]</p><p>4/4 </p>