Attachment_1b_-_Sample_Travel_Request.pdf
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- Solicitation number
- N00421-17-R-0071
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Travel Req
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Sample Travel Authorization Request Form N00421‐17‐R‐0071
Contract Number
Travel Number
Traveller
Functional Work Group
GovCC/ACRN
Govt POC
Purpose
Location(s)
Travelling with
Specific Trip Requirements
Location 1 Location 2 Location 3
Location/Area
Per Diem ‐ Lodging
Per Diem ‐ Meals & Expenses
Start End # of Days
Travel Dates
Travel Cost Estimate Daily Total
‐ Airfare
‐ Hotel
‐ Hotel Taxes
‐ M&IE
‐ Rental Car
‐ Gas/Parking/Tolls
‐ Baggage
‐ Other (Iist below)
Total $0 $0
Contractor TDY Request Form
This is a sample form for TDY Authorization Requests. Other forms/formats may be used. The forms to be used shall be approved by the COR. A single form shall be used across the contract for all prime and sub contractors.
(Identify non‐standard aspects of trip and why it is needed. E.g. multiple rental cars, high expense travel, use of govt transport, staying aboard ship, etc)
SOW Attachment 1b, p1
Sample Travel Authorization Request Form N00421‐17‐R‐0071
Contract Number
TDY Serial Number Format
Tccx‐yyy T ‐ Travel cc ‐ Contract # (last 2 digits), e.g. use 11 for N00421‐19‐C‐0011 x ‐ A=Base; B=Option 1; C=Option 2; D=Option 3, E=Option 4
Travel Number yyy ‐ Sequential number for TDY; no gaps; does NOT restart for new option period
Traveller
Functional Work Group
GovCC/ACRN
Govt POC
Purpose
Location(s)
Travelling with
Specific Trip Requirements
Location/Area
Per Diem ‐ Lodging
Per Diem ‐ Meals & Expenses
Travel Dates
Travel Cost Estimate
Total column should be Daily rate x number of days. For non‐daily charges, just enter total.
Only one traveller per Travel Number
Assigned by the Govt
Per Diem Locations that match up with Location(s) above. Use Per Diem Table nomenclature.
Place where work will be performed. Not just City/State. If more than one location, describe itinerary in requirem
Other contractors on this trip.
Describe any trip anomolies that are not the standard: goto a/p, fly, get compact rental car, Perform TDY, return.
E.g. 2 people on same trip, each getting a car due to different work schedules; driving equipment van to TDY site, and flying back.
Assigned by the Govt
Govt person requesting the trip
Short purpose/title to easily reference this trip
Form Instructions
Full contract number of awarded contract e.g. N00421‐19‐C‐0011
Ensure estimated costs that are daily charges are listed in daily column.
Planned to and from dates
‐‐ Exception is Hotels and M&IE since they are based on Per Diem rates
Total should be a Not To Exceed value. Not looking for exact costs for most things.
SOW Attachment 1b, p1
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