Attch_8__PBSOW_Appendix_F_-_Sample_Travel_Authorization_Form.pdf

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Attached to
Support Enterprise Student Administration and Scheduling System (SASS) Federal contract opportunity
Solicitation number
HSFLGL-16-R-00026
Issued by
Department of Homeland Security Federal Law Enforcement Training Center

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PBSOW Appendix F - Sample Travel Authorization Form

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FEDERAL LAW ENFORCEMENT TRAINING CENTERS (FLETC) RFP HSFLGL-16-R-00026

STUDENT ADMINISTRATION AND SCHEDULING SYSTEM (SASS)

PBSOW Appendix F: Sample Travel Authorization Form

U.S. DEPARTMENT OF HOMELAND SECURITY

FEDERAL LAW ENFORCEMENT TRAINING CENTERS

GLYNCO, GEORGIA 31524

DATE: 01 October 2015

FROM: Company X

TO: Mr. [Contracting Officer] and Mr. [Contracting Officer Representative]

SUBJECT: SASS CLIN#XXXX - Travel Authorization Number: XXXX-XXX

Pursuant to Section 15.0, Contract No. XXXXXX-XX-X-XXXXX, CLIN No. XXXX all travel under this contract must be authorized by the Contracting Officer Representative (COR) and

Contracting Officer (CO) prior to commencing travel. Allowable expenses will be reimbursed at the rate authorized in the Federal Travel Regulation (FTR) and Federal Acquisition Regulation

(FAR) 31.205-46.

The below cost estimate is for Employee Y, Company X SASS Software Manager, to travel from

[Point of Origin] to Glynco Georgia over the period 01-03 October 2015 for an initial kickoff meeting and also to receive issue of a PIV card which will be required by FLETC by the end of the year.

Dates of Travel

TOTAL

Rates

POV

Mileage Rental Car Gas

Meals & Incidentals Lodging

Occupancy & State Tax

Parking/Tax i

Airfare Service Charge

TOTAL $ -

Total Estimate (Less G&A): $

G&A: $

TOTAL ESTIMATE (INCLUDING G&A): $

Rental Car & Gas Name Title SSN

Destination (from and to)

Airfare/POV Mileage Cost

Meals & Incidentals

Lodging & Occ/Tax

Parking/Tax i

Airfare Service Charge TOTAL

FEDERAL LAW ENFORCEMENT TRAINING CENTERS (FLETC) RFP HSFLGL-16-R-00026

STUDENT ADMINISTRATION AND SCHEDULING SYSTEM (SASS)

Justification: Coordination meetings with SASS PMO and issue of PIV card.

Note: Executive Order 9397 authorizes where the employee identification number is your Social

Security Number, collection of this information. Furnishing this information on this form, including your Social Security Number, is voluntary, but failure to do so may result in the disapproval of this request.

Approved/Disapproved (Please Circle)

Date: _____________________ ______________________________

Printed Name:

FLETC COR FLETC Contracting Officer

Signature:

File details come from the government source that posted it. Updated .