Fillable Printable Leave Request / Authorization Form
Fillable Printable Leave Request / Authorization Form
Leave Request / Authorization Form
FROM
7. RECOMMEND CONVALESCENT LEAVE
TO
PROVIDER'S SIGNATURE & STAMP
Information may be disclosed to the Department of Justice, and to federal, state, local or foreign law enforcement authorities for investigating or
I acknowledge that the leave requested by me will be charged against my leave account unless otherwise cancelled or corrected
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
16. LEAVE ADDRESS (Street, City, State, Zip Code, and Phone No.)
1. DATE OF REQUEST
3. SSN (6-14) 4. NAME (Last, First, Middle Initial) (15-19) 6. CURRENT LV BALANCE 5. GRADE 6a. DOS
REMARKS:
15. EMERGENCY PHONE NO.
17. DUTY PHONE NO. 18. UNIT 19. DUTY SECTION
20. DUTY LOCATION
23. SUPERVISOR'S NAME AND GRADE (Print or Type) 24. DUTY PHONE
29. TOTAL LEAVE APPROVED
31. COMMANDER'S SIGNATURE/GRADE 32. AUTHORIZATION DATE 30. UNIT HEADQUARTERS
Permissive TDY (T)
Reenlist ment
Other (Specify)
Gra duat ion (J)
Special (H)
Terminal (P)
Emergency (D)
A
ppe llat e Re view (R)
LEAVE REQUEST/AUTHORIZATION
(See Privacy Act Statement and General Instructions below)
12. FIRST DAY OF CHARGEABLE
(47-52)
10. LEAVE AUTH NO.
(37-43)
9. NO. DAYS REQUESTED
(33-35)
13. LAST DAY OF CHARGEABLE
(53-58)
TO: ACFP
2. TYPE OF TRANSACTION
(1-5) (AFO Use Only)
SECTION I
8. TYPE OF LEAV
E
(Check o ne)
Convalescent (F)
Ordinary (A)
(AFI 36-3003)
PTDY Reas on
11. FIRST DAY/TIME OF LV STATU
S
14. LEAVE AREA (36)
CONUS OS OS to CONUS
21. MEMBER'S SIGNATURE 22.
LEAVE I
S
DATE
25. SUPERVISOR'S SIGNATURE
DISAPPROVED
A
PPROVED
LEAVE REQUE ST CERTIF I CATION:
p
ay, or any other money due me. I have read the instructions on PART II.
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 For ce; howev er, I cons ent to thi s
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
5. GUIDELINES FOR CHARGING LEAVE AND INSTRUCTIONS FOR LEAVE ADJUSTMENTS ARE PRINTED ON PART III.
1. THIS FORM MUST BE TYPED OR COMPLETED IN INK.
2. BEFORE SEPARATING PARTS I, II, AND III, COMPLETE THE FOLLOW ING BLOCKS:
a. Blocks 1 thru 5, 9, 12 thru 21, and 23 thru 25 are self-explanatory.
PREVIOUS EDITION WI LL BE USED.
SECTION II
(To be completed by supervisor/unit commander to authorize advance or excess leave)
26. LEAVE AVAILABLE TO ET
S
(From LES)
27. ADVANCE LEAVE REQUESTED
(Bloc k 9 minu s 6)
28. EXCESS LEAVE REQUESTED
(44-46) (Block 9 minus 26)
OVER 30 DAY
S
33. AUTHORITY FOR ADVANCE LEAV
E
PRIVACY ACT ST ATEMENT
AUTHORIT
10 U.S.C., Chapter 40; 37 U.S.C., Chapter 9; EO 9397, November
PRINCIPAL PURPOSES:
contacted in case of emergency during leave; and certify leave days chargeable to
To autho rize mil itary leav e, documen t the star t and stop of su ch leave; record address and telephone number where you may be
ROUTINE USES:
emergency situations.
p
rosecuting a violation or potential violation of law; the American Red Cross for information concerning the needs of the member or dependents and relatives in
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.)
AF IMT 988, 19910901, V4
PART I - AFO COPY
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. Bloc k 7. This bl ock will be co mpleted, signed, and stamped by the appr opriate me dical auth ority if convale scent le ave is rec omme nded .
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. Superv isor or des ignee obta ins a leav e authorization nu mber from th e unit order ly room imme diatel y before s igning 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). I f th e requ est ed le av e exc eed s t he c urre nt ba lance 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 THI S 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.
14. LEAVE AREA
I acknowledge that the leave requested by me will be charged against my leave account unless otherwise cancelled or corrected
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
16. LEAVE ADDRESS (Street, City, State, Zip Code, and Phone No.)
1. DATE OF REQUEST
3. SSN (6-14) 4. NAME (Last, First, Middle Initial) (15-19) 6. CURRENT LV BALANCE 5. GRADE 6a. DOS
REMARKS:
15. EMERGENCY PHONE NO.
17. DUTY PHONE NO. 18. UNIT 19. DUTY SECTION
20. DUTY LOCATION
23. SUPERVISOR'S NAME AND GRADE (Print or Type) 24. DUTY PHONE
Permissive TDY (T)
Reenlist ment
Other (Specify)
Gra duat ion (J)
Special (H)
Terminal (P)
Emergency (D)
A
ppe llat e Re view (R)
LEAVE REQUEST/AUTHORIZATION
(See Privacy Act Statement and General Instructions below)
12. FIRST DAY OF CHARGEABLE
(47-52)
10. LEAVE AUTH NO.
(37-43)
9. NO. DAYS REQUESTED
(33-35)
13. LAST DAY OF CHARGEABLE
(53-58)
TO: ACFP
2. TYPE OF TRANSACTION
(1-5) (AFO Use Only)
SECTION I
FROM
7. RECOMMEND CONVALESCENT LEAVE
8. TYPE OF LEAV
E
(Check o ne)
TO
PROVIDER'S SIGNATURE & STAMP
Convalescent (F)
Ordinary (A)
(AFI 36-3003)
PTDY Reas on
11. FIRST DAY/TIME OF LV STATU
S
(36)
CONUS OS OS to CONUS
21. MEMBER'S SIGNATURE 22.
LEAVE I
S
DATE
25. SUPERVISOR'S SIGNATURE
DISAPPROVED
A
PPROVED
LEAVE REQUE ST CERTIF I CATION:
p
ay, or any other money due me. I have read the instructions on PART II.
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 For ce; howev er, I cons ent to thi s
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
1. If you take more leave than you will accumulate before date of separation (DOS), the AFO immediately collects all pay and allowances you receive
during the period of excess leave.
2. Re memb er :
a. Your leave is normally effective on the date you include in your leave request as "first day of chargeable leave."
b. If you want to change your starting or projected return date before departing on leave, you must notify the leave-approving authority.
c. When you sign up for space-available transportation, you have started a period of leave. Once space-available travel has been signed for, leave is
charged according to the table on Part III. (Authority: AFR 35-9).
3. You must be in the local area of your permanent duty station before start, and upon completion of leave. Local area is defined as the place of
residence or home from which the member commutes to the duty station on a daily workday basis.
4. Before departure, you must have an approved leave authorization (AF Form 988, Leave Request/Authorization) or special order and enough funds for
expenses, including costs for travel. Do not assume you can return on time by military air transportation.
5. You must be able to be contacted through the address or phone number shown on your leave authorization. Members with key mobility deployment
responsibilities must notify their unit mobility officer, NCO or alternate of scheduled leave as soon as possible before departure.
6. If you need an extension of leave, call or send a telegram to the individual who approved your leave. If you are on emergency leave, ask the nearest
American Red Cross chapter to verify the continuing emergency to the leave-approving authority.
7. If you require medical or dental treatment while on leave, go to the nearest uniformed services treatment facility. If you must be treated for an
emergency at a civilian facility, instruct the civilian source of care to submit a claim for payment to the nearest Air Force medical treatment
facility/Resource Management Office. The claim must be itemized, including diagnosis, medical records, your pay grade, military address, and SSN.
a. If you are hospitalized in a military medical treatment facility, ensure that your organization of assignment is notified as soon as possible.
b. If you are hospitalized in a civilian facility, notify the nearest Air Force medical treatment facility (Patient Affairs Office) as soon as possible
8. If you are in need of funds, go to the nearest Air force finance office and show this leave form and current Leave and Earnings Statement (LES).
Casual payments, if authorized, cannot exceed unpaid pay and allowances to date. If you do not have your LES, you may experience a delay.
9. Observe all traffic rules if you travel by automobile.
10. If you plan to travel by commercial air at reduced rates, contact the airline to learn what documents you need.
11. It is your responsibility to return to your permanent duty station or obtain a leave extension from your supervisor before expiration date of your leave.
12. If traveling by DOD-owned aircraft, MAC contract flights, or commercial air, you must comply with dress requirements according to AFR 35-10,
Chapter 6.
13. Personnel possessing a DD Form 714, Meal Card, or DD Form 2 AF, when used in lieu of a meal card, must not use either identification to obtain
meals while on leave.
14. During PTDY, days not used for reason stated in Section I, block 8, are chargeable as leave. Proof of use may be required.
15. You must meet all appointments while on leave or reschedule the appointments before departure.
16. Before you depart on leave, you should complete DD Form 2258. Temporary Mail Disposition Instructions, at the Postal Service Center, to direct your
mail during your leave.
DATE ARR CONUS DATE DEPART CONUS
AF IMT 988, 19910901, V4
DUTY STATION
DATE/TIME DEPART PERM
DUTY STATION
DATE/TIME RETURN PERM
PAY AREA
DATE DEPART DESG
PAY AREA
DATE RETURN DESG
INSTRUCTIONS FOR MEMBERS DEPARTING ON LEAVE
PART II - MEMBE R'S COPY
SECTION II
(For member's use to record data for leave originating outside CONUS)
If Space A transportation was used, it was signed up for on
not used.
DATE/TIME DEPART PERM
SECTION III - HOW DID ACTUAL LEAVE COMPARE TO THE LEAVE REPORTED IN BLOCKS 12 AND 13 ABOVE?
16. LEAVE ADDRESS (Street, City, State, Zip Code, and Phone No.)
1. DATE OF REQUEST
3. SSN (6-14)
4. NAME
(Last, First, Middle Initial) (15-19)
6. CURRENT LV BALANCE 5. GRADE 6a. DOS
REMARKS:
15. EMERGENCY PHONE NO.
17. DUTY PHONE NO. 18. UNIT 19. DUTY SECTION
20. DUTY LOCATION
Permissive TDY (T)
Reenlist ment
Other (Specify)
Gra duat ion (J)
Special (H)
Terminal (P)
Emergency (D)
A
ppe llat e Re view (R)
LEAVE REQUEST/AUTHORIZATION
(See Privacy Act Statement and General Instructions below)
12. FIRST DAY OF CHARGEABLE
(47-52)
10. LEAVE AUTH NO.
(37-43)
9. NO. DAYS REQUESTED
(33-35)
13. LAST DAY OF CHARGEABLE
(53-58)
TO: ACFP
2. TYPE OF TRANSACTION
(1-5) (AFO Use Only)
SECTION I
FROM
7. RECOMMEND CONVALESCENT LEAVE 8. TYPE OF LEAV
E
(Check o ne)
TO
PROVIDER'S SIGNATURE & STAMP
Convalescent (F)
Ordinary (A)
(AFI 36-3003)
PTDY Reas on
11. FIRST DAY/TIME OF LV STATU
S
14. LEAVE AREA (36)
CONUS OS OS to CONUS
Duty
Leave
No
if the member
Departs or signs
up for space-
avail abl e t r avel
Returns
5. If the member returns from leave on Saturday, regardless of the hour, Saturday is a day of leave. This rule also applies if return is on Sunday.
and has pe rforme d over 50
percent of scheduled duty
used
SUPERVISOR'S NAME AND GRADE (Print or Type) DUTY PHONE NO. DATE
DATE ARR CONUS DATE DEPART CONUS
AF IMT 988, 19910901, V4
SECTION II - MEMBER
(Use to record data for leave originating outside CONUS)
new leave request to the AFO. Process Part III of the new leave request as normal upon member's return.
If the member departs before or after the first day of leave status indicated in Section I of Part I, cancel the original leave request and prepare a new
request using a new leave authorization number. Complete Section III of Part III of the original leave request and forward to the unit. forward Part I of the
for first day of chargeable leave)
TOTAL NUMBER OF DAYS TAKEN (See Block 12
LEAVE IS
:
CORRECT LAST DAY OF CHARGEABLE
PART III - UNIT C OPY
D
E
A
B
C
CHECK ONE, AND COMPLETE
DESIGNATED SUBSECTION
No change (Complete subsections C, D and E only)
Last day should be correcte d (Complete su bsecti ons B thru E)
Should be cancelled (Complete subsection E only)
IF LEAVE WAS EXTENDED, EXTENSION WAS APPROVED B
Y
Space A transportation was
(date)
THIS IS A TRUE AND CORRECT ST ATEMENT OF LE AVE TAKEN
I make this statement with the full knowledge of the penalties for willfully making a false statement.
Intentional misstatements or omissions of facts constitute federal criminal violations. (Maximum
penalties:$10,000 fine or 5 years imprisonment, or both. 18 U.S.C. 1001. Also see Article 107, UCMJ)
MEMBER'S SIGNATURE
In consideration of the last duty day before starting leave and the first day after return from leave, or member's cancellation request, and in clud ing all
other information available, I certify the above days of leave used, or cancelled, are true and correct to the best of my knowledge and belief. (See
below for computing chargeable leave.)
SUPERVISOR'S SIGNATURE
INSTRUCTIONS FOR CHARGING LEAVE
Examples: Using a normal work schedule of Monday through Friday, 0730 to 1630.
1. If the member departs the local area or signs up for Space-A travel on
Tuesday, and if the leave-approving authority determines that the majority
(over 50%) of schedule duty was performed, Tuesday is a day of duty and
W ednesday is the first day of leave.
2. If the member departs the local area or signs up for Space-A travel on
Saturday, regardless of the hours, that day is a day of duty and Sunday is
the first day of leave.
3. If departure from the local area or sign-up is on Sunday, regardless of
the hour, that day is a day of duty and Monday is the first day of leave.
4. If the member returns from leave on Friday, and if the leave-approving
authority determines that the majority (over 50%) of scheduled duty was
p
erformed, Friday is a day of duty and Thursday is the last day of leave.
above examples use Monday through Friday as normally scheduled workdays; however, for members on shift work, equivalent schedules will be arranged
though the days of the week vary.) NOTE: W hen the member signs up for s pac e-av ail able t rans por tat ion, the m ember has sta rte d a period of leave and it
is charged as indicated above. Authority: AFR 35-9.)
X
X
on a
nonduty
day
then duty
status is
Leave
Duty
Duty
Leave
X
X
Yes
X
X
INSTRUCTIONS FOR COMPLETING AND PROCESSING PART III
Upon member's return from leave or cancellation, complete (separately) Section III of Part III. Determine how the member's actual leave dates compared
to the chargeable leave reported to the AFO on Part I. complete Section III to indicate either "no change," "should be corrected," or "should be cancelled."
IMPORTANT: Al l periods aw aiting spa ce availab le trans portatio n are charge able as leav e accord ing to normal ru les for char ging leave (see guidel ines for
charging leave above). After completing Part III, separate and immediately forward to your unit orderly room. If you must alter any Section III data after
initi ally compl eting, lin e through an d initial th e incorrec t data or bloc k.
LEAVE START DATE ADJUSTMENTS
DUTY STATION DUTY STATION
DATE/TIME RETURN PERM
PAY AREA
DATE DEPART DESG
PAY AREA
DATE RETURN DESG
