Att 11 (DRAFT) - Request for Travel Authorization (RFTA) Form.pdf

OVERTIME APPROVAL YES NO

REQUEST FOR TRAVEL AUTHORIZATION (RFTA)

TODAYS DATE: CONTRACT/TO# W9133L-

NAME: COMPANY:

DUTY POSITION: WORK PHONE:

# OF DAYS: BEGIN TRAVEL DATE: END TRAVEL DATE:

TDY LOCATION: PER DIEM RATE: LODGING $ M&IE $

TDY LOCATION: PER DIEM RATE: LODGING $ M&IE $

TDY LOCATION: PER DIEM RATE: LODGING $ M&IE $

FOR PER DIEM RATES: https://secureapp2.hqda.pentagon.mil/perdiem/perdiemrates.html

PURPOSE/JUSTIFICATION:

Resource Labor Code Not to Exceed (NTE) OT

Hours

Per Hour Rate Maximum OT Labor

APPROVED DISAPPROVED _________________________________________________________

(CONTRACTING OFFICER)

PRIMARY MODE OF TRAVEL:

COMMERCIAL AIRFARE: OTHER (I.E. RAIL) $ COST $

POV MILEAGE ONE WAY

ITINERARY:

FROM: TO:

FROM: TO:

FROM: TO:

PLEASE CHECK THE APPROPRIATE RESPONSE FOR THE FOLLOWING:

RENTAL CAR AUTHORIZED: YES NO TOTAL EST. COSTS:

IN/AROUND AREA MILEAGE: YES NO

CONFERENCE FEES: YES NO AMOUNT $

WILL YOU TRAVEL BY POV FROM YOUR HOME TO THE AIRPORT? YES NO

IF YES, ENTER THE ONE WAY MILEAGE

Other Expenses: 1ST & Last Days @ 75% of M&IE $

Rental Car: $ 1ST Night Lodging $

Fuel: $ Full Days of Per Diem $

Hotel Taxes: $ Total Estimated Per Diem $

Bag Fees: $ Flight / Mileage Cost Estimate: $

Airport Parking: $ Other Expenses Listed: $

Hotel Parking: $ 2407 (Repairs) $

Tolls: $

Total: $ Total Estimated Travel Cost: $

Plus Maximum OT Labor Cost $

Note: Full Per Diem consists of the daily rate for Lodging, Meals & Incidental Expenses (M&IE).

APPROVED DISAPPROVED SEE ME ________________________________________________________

(BRANCH/DIVISION CHIEF SIGNATURE)

REVIEWED/CONCUR: YES NO ________________________________________________________

(CONTRACTOR MANAGER APPROVAL)

AUTHORIZED: YES NO ________________________________________________________

(COR/COTR AUTHORIZATION)

DRAFT

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