TRAVEL AUTHORIZATION REQUEST
PRIVACY ACT STATEMENTAuthority: 31 USC 3511, 3512, and 35232; 5 USC Chapter 57 and implementing Federal Travel Regulations (41 CFR parts 301-304).
Principal Purpose(s): Used to provide a request for authorization of official travel and a method of requesting and confirming travel
arrangements. The form is used as a basis for preparing travel reservations. It remains part of the file for the reservations involved.
Routine Use(s): To provide travel documents for individual on official Federal government business.
Disclosure: Voluntary; however, completion of the form is necessary before travel arrangements can be made. Failure to provide any
of the requested information (including SSN) may result in incomplete travel arrangements.
Name:
SSN:
EXT:
Travel Card Holder: Yes_____ No __ ___ Need card activated? Yes _____ No _____
Source of Funding:
Appropriated_____
Reimbursable_____
Cost Code _________________________
No Cost _____
Gift_____
Invitational _____
Purpose of Travel:
Date Travel Begins:
Date Travel Ends:
Departure Time:
Departure Time:
Arrival Time:
Arrival Time:
Destination:
BOQ? If yes, cost per night: $
Lodging per night: $
Registration/Conference Fee: $
ATM Advance: Yes_____ No _____
Method of Travel:
Personal (POV) _______
Government Vehicle_______
Airplane _______
Rental Car _______
Rail_________
Other _______
If POV, approximate mileage roundtrip:
Estimated cost: $
Cost of Airplane/Other ticket: $ _________________
Rental Car? If Yes _____, cost per day: $ ______________
No _____
Per Diem Costs: $_________
(http://www.gsa.gov/Portal/gsa/ep/contentView.do?contentType=GSA_BASIC&contentId=17943)
Miscellaneous expenses: (tolls, gas, parking fees, etc)? Yes ___ No___ __ Estimated total miscellaneous costs: $__________
Additional Comments for travel: ____________________________________________________________________________
_______________________________________________________________________________________________________
TOTAL TRIP ESTIMATED COST $______________
Funds Avail:_____
Funds Not Avail:_____
Approved_____
Disapproved_____
USNA NNB 4650/2(2-07)
______________________________________
Financial Officer
______________________________________
Department Chair