Public Transportation Benefit Program Application - United States Air Force Outside The National Capital Region Page 2
ADVERTISEMENT
1
2MASS TRANSPORTATION BENEFIT PROGRAM
DEPARTMENT OF THE AIR FORCE - OUTSIDE THE NATIONAL CAPITAL REGION
COMMUTER EXPENSES CALCULATION WORKSHEET
Calculate your MONTHLY MASS TRANSPORTATION EXPENSES based on the way (daily, weekly, monthly) that you pay for your commute. Round
your expenses to the nearest dollar. Parking fees are not eligible for reimbursement and will not be included in your calculations.
Complete and sign this worksheet and submit it to your installation POC along with your MTBP application form. If your commuting costs change, you
must complete a new worksheet and submit it to your POC, along with a new application form for "Making a Change".
APPLICANT NAME (Last, first, MI):
DATE:
EMPLOYEE CERTIFICATION WARNING:
This certification concerns a matter within the jurisdiction of an agency of the United States and making a false, fictitious, or fraudulent certification may
render the maker subject to criminal prosecution under Title 18, United States Code, Section 1001, Civil Penalty Action, providing for administrative
recoveries of up to $10,000 per violation, and/or agency disciplinary actions up to and including dismissal.
I certify that I am employed by the above mentioned Federal Agency and am not named on a federally subsidized workplace parking permit with this or
any other Federal agency, or that I will relinquish my permit before or upon receiving the fare benefit.
I certify that I am eligible for a public transportation fare benefit, will use it for my daily commute to and from work, and will not transfer it to anyone else.
SECTION I. COMMUTING COST CONVERTER
40 HOUR AND COMPRESSED WORKWEEK SCHEDULE CONVERTER
Please complete the conversion that applies to your work schedule commute.
a. 8 hour workday conversion
Daily Cost:$________________
21
Days Worked
Total:$__________________
b. 9 hour workday conversion
Daily Cost:$________________
19
Days Worked
Total:$__________________
c. 10 hour workday conversion
Daily Cost:$________________
17
Days Worked
Total:$__________________
d. Other Work Schedule conversion
Daily Cost:$________________
Days Worked
Total:$__________________
4
e. Weekly Work Schedule conversion
Weekly Cost:$_______________
Total:$__________________
Wks per Month
SECTION II. CALCULATING YOUR MASS TRANSPORTATION EXPENSES
Complete only those items that apply to your commute.
Parking fees are not eligible for reimbursement and will not be included in your calculations.
TRANSPORTATION TO WORK:
COMPANY NAME
DAILY EXPENSE
WEEKLY EXPENSE
MONTHLY EXPENSE
BUS:
$
$
$
TRAIN:
$
$
$
VANPOOL:
$
$
$
OTHER:
$
$
$
TRANSPORTATION FROM WORK:
COMPANY NAME
DAILY EXPENSE
WEEKLY EXPENSE
MONTHLY EXPENSE
BUS:
$
$
$
TRAIN:
$
$
$
VANPOOL:
$
$
$
OTHER:
$
$
$
TOTAL MONTHLY COST: $______________
I certify that the monthly transit benefit I am receiving does not exceed my monthly commuting costs.
APPLICANT SIGNATURE:
POC SIGNATURE:
ADVERTISEMENT
0 votes
Related Articles
Related forms
Army Mass Transportation Benefit Program Outside The National Capital Region Application Form
Business
Application For Advertisement Approval Form - Housing And Land Use Regulatory Board Expanded National Capital Region Field Office
Legal
Application For Approval Of Condominium Plan Form - Expanded National Capital Region Field Office
Legal
Related Categories
Parent category: Business