Digital Signature and Advance Operating Allowance
(Read Privacy Act Statement on back before completing form.) 3. MEMBER OR EMPLOYEE INFORMATION
a. NAME (Last, First, Middle Initial) b. RANK/GRADE c. SSN d. AGENCY
APPLICATION FOR DO IT YOURSELF MOVE AND COUNSELING CHECKLIST
1. DATE PREPARED 2. SHIPMENT NUMBER (YYYYMMDD)
4. THIS SHIPMENT/STORAGE IS REQUIRED INCIDENT TO THE FOLLOWING ORDERS:
a. TYPE ORDERS (X one) LOCAL PERMANENT TEMPORARY g. NAME OF PREPARING OFFICE h. PAYING (AFO/F&AO) NAVY AND MARINE CORPS d. NEW DUTY ASSIGNMENT e. ORDERS NO. f. NUMBER OF MILES b. DATE OF ORDERS (YYYYMMDD) c. ISSUED BY
5. SEND CHECK TO: (Complete address) 7. ENTITLEMENTS (X and complete as applicable) a. Option of GBL (Van) and/or DITY move (nontemporary storage). b. DITY move authorized from to c. ITO/TMO provided with accurate estimate weight of HHGs. d. Maximum authorized weight. e. Unauthorized items (POV's, flammables, etc.). f. Power of Attorney, if required. g. Type of vehicle authorized (POV). h. Loss or damage - maximum government liability. i. Temporary storage. 9. COST COMPUTATION
a. ESTIMATED CONSTRUCTIVE COSTS (1) MTMC RATE SOLICITATIONS PLUS $5.00 PER CWT X EST. WT. OR WT. ALLOWANCE (2) LOCAL RATE PER CWT X EST. WT. OR WT. ALLOW. (3) ESTIMATED GROSS INCENTIVE (4) ADVANCE OPERATING ALLOWANCE b. PAID BY DSSN
6. STATE OF LEGAL RESIDENCE 8. MEMBER RESPONSIBILITY (X and complete as applicable) a. Operating allowance (amount): b. Pick up rental vehicle and ensure safe operation. Pick up date (YYYYMMDD): c. Empty/loaded weight tickets required for each trip made. Use government, public, commercial scales. d. Name, rank, Social Security Number, Weighmaster's signature required on each weight ticket. e. Trailers weighed attached to prime mover (no passengers aboard - weigh entire unit at same time). f. DITY moves require DD Form 1351-2. g. DD Form 2278 and weight tickets must be submitted to paying office/TMO/ITO to receive incentive payment. Provide Rental Contract (not required for Air Force and Army.)
$ $ $ $
c.
a. NAME (Last, First, Middle Initial) b. RANK/GRADE c. SSN d. AGENCY
APPLICATION FOR DO IT YOURSELF MOVE AND COUNSELING CHECKLIST
1. DATE PREPARED 2. SHIPMENT NUMBER (YYYYMMDD)
4. THIS SHIPMENT/STORAGE IS REQUIRED INCIDENT TO THE FOLLOWING ORDERS:
a. TYPE ORDERS (X one) LOCAL PERMANENT TEMPORARY g. NAME OF PREPARING OFFICE h. PAYING (AFO/F&AO) NAVY AND MARINE CORPS d. NEW DUTY ASSIGNMENT e. ORDERS NO. f. NUMBER OF MILES b. DATE OF ORDERS (YYYYMMDD) c. ISSUED BY
5. SEND CHECK TO: (Complete address) 7. ENTITLEMENTS (X and complete as applicable) a. Option of GBL (Van) and/or DITY move (nontemporary storage). b. DITY move authorized from to c. ITO/TMO provided with accurate estimate weight of HHGs. d. Maximum authorized weight. e. Unauthorized items (POV's, flammables, etc.). f. Power of Attorney, if required. g. Type of vehicle authorized (POV). h. Loss or damage - maximum government liability. i. Temporary storage. 9. COST COMPUTATION
a. ESTIMATED CONSTRUCTIVE COSTS (1) MTMC RATE SOLICITATIONS PLUS $5.00 PER CWT X EST. WT. OR WT. ALLOWANCE (2) LOCAL RATE PER CWT X EST. WT. OR WT. ALLOW. (3) ESTIMATED GROSS INCENTIVE (4) ADVANCE OPERATING ALLOWANCE b. PAID BY DSSN
6. STATE OF LEGAL RESIDENCE 8. MEMBER RESPONSIBILITY (X and complete as applicable) a. Operating allowance (amount): b. Pick up rental vehicle and ensure safe operation. Pick up date (YYYYMMDD): c. Empty/loaded weight tickets required for each trip made. Use government, public, commercial scales. d. Name, rank, Social Security Number, Weighmaster's signature required on each weight ticket. e. Trailers weighed attached to prime mover (no passengers aboard - weigh entire unit at same time). f. DITY moves require DD Form 1351-2. g. DD Form 2278 and weight tickets must be submitted to paying office/TMO/ITO to receive incentive payment. Provide Rental Contract (not required for Air Force and Army.)
$ $ $ $
c.