Fillable Leave Request Authorization printable pdf download

SECTION I

1. DATE OF REQUEST

2. TYPE OF TRANSACTION

LEAVE REQUEST/AUTHORIZATION

(1-5) (AFO Use Only)

TO: ACFP

(See Privacy Act Statement and General Instructions below)

3. SSN (6-14)

4. NAME (Last, First, Middle Initial) (15-19)

5. GRADE

6. CURRENT LV BALANCE

6a. DOS

7. RECOMMEND CONVALESCENT LEAVE

8. TYPE OF LEAVE

PTDY Reason

Terminal (P)

Reenlistment

(Check one)

(AFI 36-3003)

FROM

Emergency (D)

Graduation (J)

Ordinary (A)

Appellate Review (R)

Other (Specify)

Convalescent (F)

Special (H)

Permissive TDY (T)

REMARKS:

PROVIDER'S SIGNATURE & STAMP

9. NO. DAYS REQUESTED

10. LEAVE AUTH NO.

11. FIRST DAY/TIME OF LV STATUS

12. FIRST DAY OF CHARGEABLE

13. LAST DAY OF CHARGEABLE

(53-58)

(33-35)

(37-43)

(47-52)

14. LEAVE AREA (36)

15. EMERGENCY PHONE NO.

16. LEAVE ADDRESS (Street, City, State, Zip Code, and Phone No.)

CONUS

OS to CONUS

17. DUTY PHONE NO.

18. UNIT

19. DUTY SECTION

20. DUTY LOCATION

I acknowledge that the leave requested by me will be charged against my leave account unless otherwise cancelled or corrected

LEAVE REQUEST CERTIFICATION:

through Part III of this form. In addition, if I cannot earn enough leave before separation to cover this request, I consent to withholding from current pay, final pay, or

any other pay due me to satisfy this indebtedness. I understand that there is no actual debt until my final separation from the Air Force; however, I consent to this

withholding of pay in anticipation of the indebtedness for the unearned portion of my leave balance. I further consent to such withholding at a rate sufficient to satisfy

this indebtedness no later than my requested or projected separation date, and understand that this could result in the withholding of 100% of any current pay, final

pay, or any other money due me. I have read the instructions on PART II.

21. MEMBER'S SIGNATURE

22.

LEAVE IS

APPROVED

DISAPPROVED

DATE

23. SUPERVISOR'S NAME AND GRADE (Print or Type)

24. DUTY PHONE

25. SUPERVISOR'S SIGNATURE

SECTION II

(To be completed by supervisor/unit commander to authorize advance or excess leave)

26. LEAVE AVAILABLE TO ETS

27. ADVANCE LEAVE REQUESTED

28. EXCESS LEAVE REQUESTED

29. TOTAL LEAVE APPROVED

(From LES)

(Block 9 minus 6)

(44-46) (Block 9 minus 26)

30. UNIT HEADQUARTERS

31. COMMANDER'S SIGNATURE/GRADE

32. AUTHORIZATION DATE

33. AUTHORITY FOR ADVANCE LEAVE

OVER 30 DAYS

PRIVACY ACT STATEMENT

AUTHORIT

10 U.S.C., Chapter 40; 37 U.S.C., Chapter 9; EO 9397, November

PRINCIPAL PURPOSES:

To authorize military leave, document the start and stop of such leave; record address and telephone number where you may be

contacted in case of emergency during leave; and certify leave days chargeable to

ROUTINE USES:

Information may be disclosed to the Department of Justice, and to federal, state, local or foreign law enforcement authorities for investigating or

prosecuting a violation or potential violation of law; the American Red Cross for information concerning the needs of the member or dependents and relatives in

emergency situations.

DISCLOSURE:

Disclosure of SSN is voluntary. However, this form will not be processed without your SSN, since the Air Force identifies members by SSN for pay or

leave purposes.

GENERAL INSTRUCTIONS

(For emergency, reenlistment, convalescent, terminal, appellate review leave, and PTDY, see variations in AFM 177-373, Volume II, Ch 7.)

1. THIS FORM MUST BE TYPED OR COMPLETED IN INK.

2. BEFORE SEPARATING PARTS I, II, AND III, COMPLETE THE FOLLOWING BLOCKS:

a. Blocks 1 thru 5, 9, 12 thru 21, and 23 thru 25 are self-explanatory.

b. Block 6, current Leave Balance. Verify that the member has enough leave balance to cover the period of leave requested. This may be done by checking the

member's LES or the orderly room's leave balance listing. Complete 6a when member requests leave with a planned return date within 30 days of DOS.

c. Block 7. This block will be completed, signed, and stamped by the appropriate medical authority if convalescent leave is recommended.

d. Block 8. For PTDY, state the paragraph number of the applicable reason for PTDY as stated in AFR 35-26 and in Remarks area give abbreviated description of

purpose of PTDY. (For example: base baseball team.)

e. lock 10. Leave Authorization Number. Supervisor or designee obtains a leave authorization number from the unit orderly room immediately before signing a

leave approval and forwarding Part I to AFO. Do not get leave number earlier than 14 days before effective date

f. Block 11. First Day/Time of Leave Status. This is the earliest time a member can depart or sign up for space available transportation. If planned departure is on a

non-duty day, enter the non-duty date and 0001 hours. If planned departure is on a duty day without performing the majority (more than 50%) of scheduled duty,

enter the date and time when more than 50% of the scheduled duty will be completed. NOTE: Leave status is not necessarily chargeable leave. Date cannot be

more than 1 day before the date in block 12. See also Part III, Instructions for Charging Leave.

g. Block 22. For PTDY, use approval level required by AFR 35-26.

h. Blocks 26-33. Complete only to authorize advance or excess leave. Blocks are self-explanatory except for blocks 27, 28, and 33.

(1) Advance Leave (Block 27). If the requested leave exceeds the current balance but does not exceed the balance to ETS, the leave is advance leave.

Complete Blocks 26-27 and forward the form (all parts) to the unit commander for approval. If a member requesting leave has a cumulative advance balance

of 30 days, comply with AFR 35-9

(2) Excess Leave (Block 28). If the requested leave exceeds the balance to ETS, the leave is excess leave. Complete Blocks 26 and 28 and forward the form

(all parts) to the unit commander for approval.

(3) Authority for Advance Leave Over 30 Days (Block 33). Record message date/time group if approval was received by message.

3. AFTER INITIALLY COMPLETING THIS FORM:

a. Separate Part I immediately after getting a leave authorization number and signing the form. forward to the AFO using normal distribution unless the leave is

terminal/separation or involves excess or advance leave. forward these requests (all parts) to the unit for approval.

b. Separate Part II and give to member.

c. Hold Part III for completion after the member's return from leave. If member requests cancellation before any leave is taken, complete Section III of Part III and

forward to your unit commander.

4. INSTRUCTIONS FOR COMPLETING AND PROCESSING PART III ARE PRINTED ON PART III.

5. GUIDELINES FOR CHARGING LEAVE AND INSTRUCTIONS FOR LEAVE ADJUSTMENTS ARE PRINTED ON PART III.

AF IMT 988, 19910901, V4

PREVIOUS EDITION WILL BE USED.

PART I - AFO COPY