Sf-1190, 2006, Foreign Allowances Application, Grant And Report
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1
2FOR E I GN A L LO WA NC ES A PPL ICA TION ,
G R A N T A N D R E P O R T ( S F - 1 1 9 0 )
F O R O F F I C I A L U S E
Voucher Number
Authonzation/
G r a n t N u m b e r
1. Employee Name (Last, First. Ml)
2. Social Security Number
3. Agency
4. tsureau/Otfrce
5 . P a y P l a n
6 . S e r i e s
E . A n n u a l S a l a r y
9 Position Title
1 0. Current Post/Country of Assignmenvlocaltty
Date of Arrival (mm-dd-yyyy)
12. Previous Post ot Assionment
1 3 . M a i l i n g A d d r e s s
l 3 a . E - m a r l A d d r e s s
14. lf Local Hire: Date (mm-dd-yyyy)
14a. Reason for Presence
15. lf Spouse is Employed by the U.S. Government
fl
ves
tl
N o
Spouse Name (Last, First. Ml)
Social Securitv Number
Allowances Kecetveo
16. Family Domiciled at Post
Name of Relative
Relationship
DOB Except
Spouse
(mm-dd-yyyy)
o /
Support
Date of Arrival
at Post
(mm-dd-yyyy)
Allowances Received
17. Family Domiciled Away from Post
Name of Relative
Relationship
DOB Except
Spouse
(mm-dd-yyyy)
Support
Date of
Departure
from Post
(mm-dd-yyyy)
Residence Address/Telephone
Cell Phone/E-mail
(please provide all)
18. Remarks
Privacy Act Statement: Solicitation of this information is authorized under 5 U.S.C. 5922, E.O.9397 and E.O. 10903, Section 1(b-2) and DSSR
Section 073.4. The information is used to determine employee eligibility for and appropriate amounts of allowances. All forms are subject to fiscal
audit by the employee's parent agency and GAO. The Office of Allowances, U.S. Department of State, will review forms to set LQA rates. Lack of
requested information may result in erroneous or unauthorized allowances.
s F - 1 1 9 0
't2-2006
Department of State Standardized Regulations (DSSR)
(Government Civilians, Foreign Areas), Section 073.4
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