Transcription of PART I - MEMBER COMPLETES THIS SECTION TO …
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Example: biology
PART I - MEMBER COMPLETES THIS SECTION TO …
STATEMENT TO SUBSTANTIATE PAYMENT OF FAMILY SEPARATION ALLOWANCE (FSA)PRIVACY ACT STATEMENTAUTHORITY:PRINCIPAL PURPOSE:ROUTINE USES:DISCLOSURE:Title 37, Code, SECTION evaluate MEMBER 's application for Serves as substantiating document for FSA payments and input into the MEMBER 's pay Provides an audit trail for validating propriety of payments and to assist in collecting erroneous Provides a record in service MEMBER 's pay account and for of your social security number and other personal information is voluntary. However, if requested informationis not provided, FSA will not be NAME OF MEMBER (Last, First, Middle Initial)3. SOCIAL SECURITY NUMBER2.
statement to substantiate payment of family separation allowance (fsa) privacy act statement authority: principal purpose: routine uses: disclosure:
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