Page 2 of CG-3453 (Rev. 6-04)
Instructions
Item Explanation
1.Enter your Full Name: Last, first, and middle Initial
2.Enter the last four digits of your Social Security Number
3.Enter your rank or rate, i.e., LCDR, YN2, PSC, etc.
4.Enter your Permanent Duty Station (include staff symbol). i.e., STA Rockland, MSO Houston, MLCPAC (lc), etc.
5.Enter Current Home Mailing Address: Street, Apt#., P.O. Box, City, State, Zip & Home phone # (work phone # optional). Check box if you desire to have your LES address changed to address indicated in Block 5.
Indicate what type of duty is to be performed. ADT-AT over 12 duty days, ADSW-RC, ADT-OTD and RMP must be approved by regional ISC (pf). ADSW-AC: Accounting data and Document ID (TONO) must be entered in Section III by the command funding the ADSW-AC, and a copy of CG-3453
6.must be forwarded to regional ISC(pf). If you are attending a "C" school, e.g., CPO Academy, Mentoring Course, TQM Training, you must attach a completed TAD Travel request, CG HRSIC-2070
7.Enter the Duty Site and OPFAC where duty is to be performed.
8.Enter Reporting Time and Date, note alternate dates in Block 23.
9.Enter Departing Time and Date, note alternate dates in Block 23.
10.Enter the total duration of duty in days.
11.Enter Purpose of Orders. i.e., OJT, Special Operations, Course of Instruction, etc. Do not use this form to request a "C" school, use form CG-5223.
12.Enter Non-consecutive periods (if known), continue in Block 23 if necessary. Report all Non-Consecutive AD utilizing Non-Consecutive Ad Endorsement Sheet (CG-5131A).
13.Enter total days of ADT-AT performed so far in the fiscal year in which this request is submitted.
14.Elect either pay or non-pay. Indicate any other variation of pay in Block 23.
Enter the quarters and messing availability at the Duty Site cited in Block 7. If quarters and messing are not available you may be entitled to Per Diem.
15.Your Commanding Officer must approve the entitlement to Per Diem in Block #21.
16.Select appropriate type of travel: 16A. Enter total round trip mileage between Duty Site and Home or Airport and Home. 16B. Enter total cost of round trip commercial transportation fare (government rate). 16C. Check if Local Travel. 16D. Indicate if you hold a Government Travel Charge Card.
17.Sign and date form. Check box if you desire a copy of your orders to be mailed to the address in Block 5 or Faxed to a provided number.
18-20 Command approval/disapproval. If request is disapproved explain in remarks (Block 23).
21.Command approval of Per Diem. Commands should contact servicing (pf) for funding approval (except for ADSW-AC). Include estimated cost in block 24.
22.Command shall enter "Program Code" as listed in Section 6-D of the Personnel & Pay Procedures Manual, HRSIC M1000.2 (series).
24.Enter Accounting Data and Document ID funding for the ADSW-AC and/or Per Diem. 24A. Signature of person authorized to approve funding.
25.ISC (pf) use Only.
23.Remarks:
Section III - Document ID and Accounting Data
24. If applicable, provide Document ID and Accounting Data below:
DIST APPN LIM CODE |
ALLOT |
PGRM |
COST |
OBJECT TYPE FY |
TONO |
SUFFIX |
EST COST |
CODE |
FUND |
ELEMENT |
CENTER |
CLASS |
|
|
|
P&A
72
FICA
72
TVL