Fillable Ae Form 190-1k - Report Of Administrative Action printable pdf download

Prescribing Directive

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FOR OFFICIAL USE ONLY

(when filled in)

REPORT OF ADMINISTRATIVE ACTION

(AE Reg 190-1/CNE-CNA-C6F Inst 11240.6X/USAFE-AFAFRICA Inst 31-202)

5. U.S. Forces certificate of

1. Name of offender (last, first, MI)

2. Grade

3. SSN

4. DOD ID no.

license no.

6. Organization

7. APO

8. Offense or violation

9. Date of offense

Day Month

Year

10. MP report no.

11. Was alcohol involved?

12. Date completed Alcohol and Drug

(German ticket no. or AE Form 190-1AX)

Prevention and Control Program

Yes

Results

If yes and a blood alcohol test was requested, enter results

or state if refused.

13. Action Taken

13a. Driving privileges revoked

13b. Driving privileges suspended

NOTE: When revocation is involved,

Duration of suspension

attach the license to this card

and mail in an envelope.

13c. Offender declared

13d. Traffic points assessed

Ineligible for driving privileges

Number of points

in accordance with

14. Effective date of action

15a. Authentication

I am the

suspending

revoking authority for the above individual.

Day

Month

Year

15b. Typed name, grade, branch, and title

15c. Signature of authority taking action

AE FORM 190-1K, JUL 16

Previous editions are obsolete.

Page 1 of 1

LCD Vers. 01.00

FOR OFFICIAL USE ONLY

(when filled in)

Fold here

FOLD TOP OF FORM DOWN, STAPLE OR TAPE-CLOSE, AND MAIL TO COMMUNITY PROVOST MARSHAL

DEFINITIONS: (See AE Reg 190-1/CNE-CNA-C6F Inst 11240.6X/USAFE-AFAFRICA Inst 31-202)

1. REVOKING AUTHORITY: An officer in the grade of major (O4) or above or a civilian supervisor in the grade of GS-12 or

above next above the suspending authority in the chain of command of a licensee. If a

commander has designated an O4 or GS-12 as the suspending authority for a unit,

organization, or group of people, the commander will be the revoking authority. With the

exception of the USAREUR Registrar and the Deputy USAREUR Registrar, a civilian revoking

authority will not revoke driving privileges of military personnel or their Family members. Such

cases will be referred to the military chain of command. For Air Force personnel, the revoking

authority will be the installation commander who may delegate his authority to the logistics

support group or mission support group commander or deputy commander.

2. SUSPENDING AUTHORITY: An officer or civilian in a licensee's chain of command who is immediately senior to the

licensee, or an officer in the grade of major (O4) or above (normally the company

commander) who has been designated by a commander as the individual who has the right

to withdraw driving privileges for a given time for members of a unit or organization. In

addition, mission support group and logistics support group commanders and deputy

commanders may withdraw driving privileges for Air Force personnel.

NOTE: Traffic points will be assessed by the suspending or revoking authority.

Ae Form 190-1k - Report Of Administrative Action

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