REQUEST AND AUTHORITY FOR LEAVE 1. …

1 REQUEST AND AUTHORITY FOR LEAVEThis form is subject to the Privacy Act of 1974. For use of this form, see AR proponent agency is ODCSPER. (See instructions on reverse.)28. DATE ISSUED13. SIGNATURE AND TITLE OFAPPROVING AUTHORITY6. LEAVE ADDRESS (Street, City, State, ZIP Code and Phone No.) III - DEPENDENT TRAVEL OF 1 AUG 75 IS OBSOLETEPART I7. TYPE OF LEAVEORDINARY EMERGENCYPERMISSIVE TDY OTHERNUMBER DAYS SUPERVISOR RECOMMENDATION/SIGNATUREAPPROVAL IV - AUTHENTICATION FOR TRAVEL AUTHORIZATIONa. DEPENDENTS (Last name, First, MI) b.

2 RELATIONSHIPc. DATES OF BIRTH (Children)d. PASSPORT NUMBER DEPENDENT LEAVE is from toPART II - EMERGENCY LEAVE TRANSPORTATION AND TRAVEL18. You are authorized to proceed on official travel in connection with emergency LEAVE and upon completion of your LEAVE and travel willreturn to home station (or location) designated by military orders. You are directed to report to the Aerial Port of Embarkation (APOE) foronward movement to the authorized international airport designated in your travel documents. All additional travel is chargeable to LEAVE .

3 Donot depart the installation without reservations or tickets for authorized space required transportation. File a no-pay travel voucher with a copyof your travel documents or boarding pass within 5 working days after your return. Submit REQUEST for LEAVE extension to your American Red Cross can assist you in notifying your commander of your REQUEST for extension of LEAVE .(Space required) TRANSPORTATION AUTHORIZED FOR DEPENDENTS LISTED IN BLOCK NO. 25(Space available or required cash reimbursable) ONE WAY ROUND TRIPUSAPPC CONTROL NUMBER 2.

4 NAME (Last, First, Middle Initial) 3. SSN 4. RANK5. DATE 8. ORGN, STATION, AND PHONE ACCRUEDb. REQUESTEDc. ADVANCEDd. EXCESSa. FROMb. TO11. SIGNATURE OF REQUESTORa. DATE b. TIME c. NAME/TITLE/SIGNATURE OF DEPARTURE AUTHORITYa. NUMBER DAYSb. DATE APPROVEDc. NAME/TITLE/SIGNATURE OF APPROVAL AUTHORITYa. DATE b. TIME c. NAME/TITLE/SIGNATURE OF RETURN AUTHORITY17. REMARKS20. DEPARTED UNIT21. ARRIVED APOD22. ARRIVED APOE (return only) 19. INSTRUCTIONS FOR SCHEDULING RETURN TRANSPORTATION:For return military travel reservations in CONUS call the MAC Passenger Reservation Center (PRC): Should you require other assistance call PAP: 29.

5 TRAVEL ORDER NUMBER 30. ORDER AUTHORIZING OFFICIAL (Title and signature) OR AUTHENTICATION26. DESIGNATION AND LOCATION OF HEADQUARTERS27. ACCOUNTING CITATION 23. ARRIVED HOME UNITORIGINAL 1DA FORM 31, SEP 93 REQUEST AND AUTHORITY FOR LEAVEThis form is subject to the Privacy Act of 1974. For use of this form, see AR proponent agency is ODCSPER. (See instructions on reverse.)INDIVIDUAL 228. DATE ISSUED13. SIGNATURE AND TITLE OFAPPROVING AUTHORITY6. LEAVE ADDRESS (Street, City, State, ZIP Code and Phone No.) III - DEPENDENT TRAVEL OF 1 AUG 75 IS OBSOLETEPART I7.

6 TYPE OF LEAVEORDINARY EMERGENCYPERMISSIVE TDY OTHERNUMBER DAYS SUPERVISOR RECOMMENDATION/SIGNATUREAPPROVAL IV - AUTHENTICATION FOR TRAVEL AUTHORIZATIONa. DEPENDENTS (Last name, First, MI) b. RELATIONSHIPc. DATES OF BIRTH (Children)d. PASSPORT NUMBER DEPENDENT LEAVE is from toPART II - EMERGENCY LEAVE TRANSPORTATION AND TRAVEL18. You are authorized to proceed on official travel in connection with emergency LEAVE and upon completion of your LEAVE and travel willreturn to home station (or location) designated by military orders.

7 You are directed to report to the Aerial Port of Embarkation (APOE) foronward movement to the authorized international airport designated in your travel documents. All additional travel is chargeable to LEAVE . Donot depart the installation without reservations or tickets for authorized space required transportation. File a no-pay travel voucher with a copyof your travel documents or boarding pass within 5 working days after your return. Submit REQUEST for LEAVE extension to your American Red Cross can assist you in notifying your commander of your REQUEST for extension of LEAVE .

8 (Space required) TRANSPORTATION AUTHORIZED FOR DEPENDENTS LISTED IN BLOCK NO. 25(Space available or required cash reimbursable) ONE WAY ROUND TRIPUSAPPC CONTROL NUMBER 2. NAME (Last, First, Middle Initial) 3. SSN 4. RANK5. DATE 8. ORGN, STATION, AND PHONE ACCRUEDb. REQUESTEDc. ADVANCEDd. EXCESSa. FROMb. TO11. SIGNATURE OF REQUESTORa. DATE b. TIME c. NAME/TITLE/SIGNATURE OF DEPARTURE AUTHORITYa. NUMBER DAYSb. DATE APPROVEDc. NAME/TITLE/SIGNATURE OF APPROVAL AUTHORITYa. DATE b. TIME c. NAME/TITLE/SIGNATURE OF RETURN AUTHORITY17.

9 REMARKS20. DEPARTED UNIT21. ARRIVED APOD22. ARRIVED APOE (return only) 19. INSTRUCTIONS FOR SCHEDULING RETURN TRANSPORTATION:For return military travel reservations in CONUS call the MAC Passenger Reservation Center (PRC): Should you require other assistance call PAP: 29. TRAVEL ORDER NUMBER 30. ORDER AUTHORIZING OFFICIAL (Title and signature) OR AUTHENTICATION26. DESIGNATION AND LOCATION OF HEADQUARTERS27. ACCOUNTING CITATION 23. ARRIVED HOME UNITDA FORM 31, SEP 93 REQUEST AND AUTHORITY FOR LEAVEThis form is subject to the Privacy Act of 1974.

10 For use of this form, see AR proponent agency is ODCSPER. (See instructions on reverse.)SUSPENSE 328. DATE ISSUED13. SIGNATURE AND TITLE OFAPPROVING AUTHORITY6. LEAVE ADDRESS (Street, City, State, ZIP Code and Phone No.) III - DEPENDENT TRAVEL OF 1 AUG 75 IS OBSOLETEPART I7. TYPE OF LEAVEORDINARY EMERGENCYPERMISSIVE TDY OTHERNUMBER DAYS SUPERVISOR RECOMMENDATION/SIGNATUREAPPROVAL IV - AUTHENTICATION FOR TRAVEL AUTHORIZATIONa. DEPENDENTS (Last name, First, MI) b. RELATIONSHIPc. DATES OF BIRTH (Children)d. PASSPORT NUMBER DEPENDENT LEAVE is from toPART II - EMERGENCY LEAVE TRANSPORTATION AND TRAVEL18.