TRAVEL HISTORY FORM - United States Naval Academy
TRAVEL HISTORY FORM
Privacy Act Statement
FOR OFFICIAL USE ONLY: PRIVACY SENSITIVE
Any misuse or unauthorized disclosure can result in both civil and criminal penalties
Authority: 5 USC 5701, 37 USC 404-427, EO 9397,31 USC 3322.31 CFR 209 and/or 210.
Principal Purpose(s): Used for reviewing, approving, accounting and disbursing for official travel.
SSN is used to maintain a numerical identification system for individual claims.
This information is confidential and is needed to prove entitlement to payments.
The information will be used to process payment data from the Federal agency
to the financial institution and/or its agent.
Routine Use(s): To substantiate claims for reimbursement for official travel.
Disclosure: Voluntary; however failure to furnish information requested may result in total
or partial denial of amount claimed and may delay or prevent the receipt of payments through the EFT/DDS programs.
Your Name:
(Last, First, & Middle Initial)
Your SSN:
Your Activity:
Your Pay Grade:
Your home street address, city, state, and zip code:
HOME PHONE NUMBER WORK PHONE NUMBER CELL PHONE NUMBER
For EFT/DDS payments, please provide the following information:
Account Type: ____ Checking ____ Savings
Account Number:
Financial Institution’s Routing Transit Number (RTN available on the bottom of your checks or from your financial institution):
Signature_________________________________________________Date:_________________________
PSDANNAP 4650/4 (8/97)
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- privacy act statement health care records
- privacy act united states department of state
- privacy act release form united states marine corps
- privacy act data cover sheet navy cnic e library
- personal data privacy act of 1974
- privacy act data cover sheet
- claim for reimbursement united states navy
- privacy act statement united states navy
- travel history form united states naval academy
- microsoft word reenlistment request cnic
Related searches
- united states history research paper topics
- history of united states education
- history of united states money
- history of united states public education
- the united states form of government
- history of united states timeline
- united states naval academy logo
- united states naval academy graduates
- united states naval air force
- united states naval air stations
- united states naval forces europe
- united states naval aviator