Fillable Sf-1190, 2009, Foreign Allowances Application, Grant And Report printable pdf download

Sf-1190, 2009, Foreign Allowances Application, Grant And Report

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FOREIGN ALLOWANCES APPLICATION,

FOR OFFICIAL USE ONLY

GRANT AND REPORT (SF-1190)

Voucher Number

1. Employee Name (Last, First, MI)

2. Social Security Number

Authorization/

3. Agency

4. Bureau/Office

Grant Number

5. Pay Plan

6. Series

7. Grade

8. Annual Salary

9. Position Title

10. Current Post/Country of Assignment/Locality

11. Date of Arrival

12. Previous Post of Assignment

13. Mailing Address

13a. E-mail Address

14. If Local Hire: Date

14a. Reason for Presence

15. If Spouse or Domestic Partner is Employed by the U.S. Government

Yes

Spouse or Domestic Partner Name (Last, First, MI)

Social Security Number

Allowances Received

16. Family Domiciled at Post

DOB Except

Date of Arrival

Spouse or

Name of Family Member

Relationship

Support

at Post

Allowances Received

Domestic Partner

17. Family Domiciled Away from Post

DOB Except

Residence Address/Telephone

Date of Departure

Spouse or

Cell Phone/E-mail

Name of Family Member

Relationship

Support

from Post

Domestic Partner

(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.

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SF-1190

Department of State Standardized Regulations (DSSR)

07-2009

(Government Civilians, Foreign Areas), Section 073.4