Appendix_H_-_Form_Data_Elements_-_DRAFT.docx
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- Attached to
- Household Goods (HHG) Relocation Services Federal contract opportunity
- Solicitation number
- HTC711-19-R-R004
About this file
This document outlines the data elements required to be collected and reported for household goods relocation services contracts. The contractor shall provide electronic and hard copy records including customer information, estimated shipment details, actual shipment details, and details of any accessorial services requested. For counseling, records require over 30 data elements including names, contact information, orders documentation, shipment details, and customer signatures. Personally procured move counseling and closeout require additional financial details. Records for Department of Defense employees assigned to the Department of State require origin and destination location information. Accessorial service records require over 15 data elements including contact information, shipment details, services requested and provided, and customer signatures. Compliance with these data reporting requirements will help the United States Transportation Command evaluate performance on household goods relocation contracts.
Appendix H - Form Data Elements - DRAFT
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Text version
HTC711-19-R-R004
Appendix H
Form Data Elements Appendix H
The contractor shall provide an electronic and/or hard copy document(s) with the following information/elements.
1. At counseling completion the contractor shall provide an electronic and hard copy record of the customer/employee’s application for shipment and/or storage of personal property with the following information:
(See Attached spreadsheet Tab 1)- Elements for all customers at application for shipment/storage
(See Attached spreadsheet Tab 2)- Elements for Personally procured move (PPM) at counseling completion and at PPM closeout
(See Attached spreadsheet Tab 3)- Elements for Department of Defense Employees Assigned to the Department of State Chief of Missions
2. Prior to service completion, the contractor shall provide an electronic and hard copy record of the accessorial services requested (crating, shuttle, storage in transit) and provide to the QAE/COR with the following information:
(See Attached Spreadsheet Tab 4) image1.emf
GHC Appendix H - Form Data Elements.xlsx Tab 1-Counseling Elements
HHG Data Elements Required after Counseling completion Notes
Last Name
First Name
Middle Initial
Total number of shipments
Last Four SSAN
DOD ID Number
Rank/Grade
Service Branch/Agency
Origin duty station
Destination duty station
Shipment Type
Weight Entitlement
Estimated Weight
Origin <GELOC>
Origin/Pick-up Address
Secondary Origin/Pick-up Address
Destination <GELOC>
Destination Address
Employee ETA at Destination
Requested Pickup Date
Requested Delivery Date
Pick-up Email
Pick-up Phone
Type Orders
Travel Authorization Number
Travel Authorization Date
Travel Authorization Issuing HQ
Intransit Email
Intransit Phone
NTS Release Info (if applicable)
NTS Expiration (if applicable)
Electronic Copy of Orders
Remarks field Capturing any information provided by the customer about their shipment
Customer signature/confirmation Establishing certification of their shipment responsibilities and storage responsibilities
Country specific forms Customs related or otherwise
Tab 2-PPM Elements
HHG Data Elements Required after PPM Counseling completion and PPM Closeout Notes
PPM Counseling Info
Last Name
First Name
Middle Initial
Last Four SSAN
Total number of shipments
DOD ID Number
Rank/Grade
Service Branch/Agency
Origin duty station
Destination duty station
Shipment Type
Weight Entitlement
Estimated Weight
Origin <GELOC>
Origin/Pick-up Address
Secondary Origin/Pick-up Address
Destination <GELOC>
Destination Address
Legal State of Residence
Employee ETA at Destination
Pickup Date
Pick-up Email
Pick-up Phone
Type Orders
Travel Authorization Number
Travel Authorization Date
Travel Authorization Issuing HQ
Intransit Email
Intransit Phone
NTS Release Info (if applicable)
Electronic Copy of Orders
Remarks field Capturing any information provided by the customer about their shipment
Customer signature/confirmation Certifying they understand tax implications and all entitlements and advance requriements
Government Constructive Cost (Maximum)
95% GCC (based on Maximum)
SIT obligation (Maximum)
Advance (Maximum)
Government Constructive Cost (Estimate)
95% GCC (based on Estimate)
SIT obligation (Estimate)
Advance (Estimate)
PPM Closeout Info
Total number of shipments
Actual Weight (at closeout)
Government Constructive Cost (Actual)
95% GCC (based on Actual)
SIT obligation (Actual)
Advance (Actual)
Line of Accounting/SDN or SAC)
TAC
Previously submitted PPM claims (advances)
Member paid expenses (total)
GTC paid expenses
Member paid SIT
GTC paid SIT
Claimable expenses (breakout) Contracted expenses, rental equipment, consumable packing materials, weighing fees, Gas, Tolls, Oil, Other
Customer signature/confirmation Certifying they understand tax implications and all entitlements and advance requriements
Orders with all amendments
Origin weight tickets (empty/Full)
Destination weight ticket (Full/Other)
Reimbursable expense receipts
Vehicle registration
DD-FMS-2231 Direct Deposit Form Prepopulated with basic info
DD1352-1 Prepopulated with basic info
Tab 3-DoS elements
HHG Data Elements Required for Shipment File Record Creation
Last Name
First Name
Middle Initial
Last Four SSAN
Rank/Grade
Agency
Origin PPSO
Destination PPSO
Shipment Type
Weight Entitlement
Origin <GELOC>
Origin/Pick-up Address
Secondary Origin/Pick-up Address
Destination <GELOC>
Destination Address
Employee ETA at Destination
Desired Survey Date
Desired Pack Begin
Pick-up Email
Pick-up Phone
Type Orders
Travel Authorization Number
Travel Authorization Date
Travel Authorization Issuing HQ
Intransit Email
Intransit Phone
NTS Release Info
Electronic Copy of Orders
Tab 4-Accessorials Elements
HHG Data Elements Required for Accessorial Services Notes
Last Name
First Name
Middle Initial
DOD ID Number
Rank/Grade
Service Branch/Agency
Origin duty station
Destination duty station
Shipment Type
Weight Entitlement
Estimated Weight
Actual Weight
Origin <GELOC>
Applicable Pick-up Address
Destination <GELOC>
Applicable Destination Address
Total Days in SIT
Type Orders
Travel Authorization Number
Travel Authorization Date
Travel Authorization Issuing HQ
Phone
Remarks field Capturing any information details on accesorial services on this shipment
Customer signature/confirmation Establishing certification of that materials were furnished/accesorial services were performed at origin, destination, or both
Total number of shipments
Crating Remarks Contractor shall annotate the actual dimensions of the item being crated (Length, Width, Height in inches) in remarks as well as proposed crating dimesions. No rounding of cubic dimensions, size will be truncated to two decimal places (e.g., 6.8055555 cu ft will be invoiced in DPS as 6.80 cu ft).
Shuttle Services Remarks and Documentation The request must include notes explaining the limitations preventing the linehaul equipment from accessing the origin/destination. The following additional documentation may be requested to support payment and post post pay audit (GSA):
a. Signed dispatch logs indicating the driver and equipment specifics used to perform the truck to truck transfer, with dates.
b. Paid equipment rental receipts (if utilized) and/or Driver Cab Logs (whichever is applicable) indicating
(1) equipment type,
(2) duration of use,
(3) date used, and
(4) location of use.
c. Copy of the vehicle registration if a vehicle from an agent was used.
Storage in transit FADD The contractor’s period of SIT eligibility begins on the FADD, and ends by the 5th working day (excluding Saturday, Sunday and holidays) after the requested delivery date(s) from storage or the actual delivery date, whichever is earlier.
Storage in transit Begin Date
Storage in transit Requested Delivery out Date
Storage in transit end date The contractor’s period of SIT eligibility begins on the FADD, and ends by the 5th working day (excluding Saturday, Sunday and holidays) after the requested delivery date(s) from storage or the actual delivery date, whichever is earlier.
Customer signature/confirmation Establishing receipt of property and confirmation that storage was provided at origin, destination, or both
Customer Requested Delivery Date
Date Customer Provided Requested Delivery Date
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