Fillable Printable Senior Federal Travel Form (Gsa Form 3641)
Fillable Printable Senior Federal Travel Form (Gsa Form 3641)
Senior Federal Travel Form (Gsa Form 3641)
GENERAL SERVICES ADMINISTRATION
GSAFORM3641(8-95)
Agency Contact Data
Aircraft Data
Flight Legs and Dates
19b. Charter19a. Govt
Passenger Data
Senior Federal Travel Form
(See Instructions on Reverse)
Interagency Report Control Form
0322-GSA-AN
1. Department/Agency2. Bureau/Office/Service
3a. Contact Name3b. Contact Title
3c. Contact Phone Number3d. Contact Fax Number
4. Aircraft Registration Number5. Aircraft Serial Number
6. Aircraft Make/Model7. Purpose of Flight8. Flight Number
9. Variable Cost per hour:10. Charter Quote:
11a. Icao
11b. Date
11c. Time
Dept Leg123456789
13. Pax No.
123456789
Arrival Leg
11d. Icao
11e. Date
11f. Time
12. Hours
14. Passenger Name
LastFirst
15. Pax Dept/
Agency
16.
Pax
Status
17.
Purp of
Travl
18. Legs
OnOff
19. Costs
20. Reimburse
Amount
19c. Carrier
Instructions for Senior Federal Travel Data Form
1.
2.
3a.
3b.
3c-d.
4.
5.
6.
7.
Department/Agency - The Federal Department or independent agency not assigned to a Department.
Bureau/Office/Service - Unit within a Department or agency (including offices and services) which dispatched the flight.
Contact Name - The name of person scheduling the flight.
Contact Title - The official title of the person scheduling flight.
Telephone and FAX Numbers - Telephone numbers for the Contact person.
Aircraft Registration Number - FAA registration number or military designated tail number.
Serial Number - The aircraft manufacturer's serial number as reported to the Federal Aviation Administration (optional).
Aircraft Make/Model - The descriptive name of the aircraft.
M =Flight is scheduled to conduct an agency mission. Such activities include the transport of troops and/or equipment,
training, evacuation, intelligence and counter-narcotics activities, search and etc. (See Title 49 CFR Part 101-37.100).
R = Required Use. Use of Government aircraft is required for bona fide communications, security needs, or exceptional
scheduling requirements.
T = Other Official Travel. Flight is scheduled for transportation of personnel on official travel other than Mission or
8.
9.
10.
11a.
11b-c.
11d.
11e-f.
12.
13.
14.
15.
16.
Flight Number - An optional agency-designated number. (*optional)
Variable Cost/Hour - The cost of operating aircraft that vary depending on how much the aircraft are used. (*optional)
Charter Quote - The cost quoted by an FAA approved charter operator (vendor) for the planned flight.
Location (departure) - The airport name for the initial departure point of the aircraft.
Date and Time - Date (month-day-year) and time of the departure (24-hour format) for first leg of the flight.
Location (arrival) - The airport name for the initial arrival point of the aircraft.
Date and Time - Date (month-day-year) and time of arrival (24-hour format) for first leg of the flight.
Hours - The flight time recorded by the pilot for the leg. (*optional)
Pax - Total number of passengers transported for this leg. (*optional)
Passenger's Name - The name of the identified traveler, last name first, first name last.
Department/Agency - The passenger's Department/agency, or bureau, or in cases of dependents, the unit for which the relative
works, or in cases of non-Federal travelers, the unit which approved their passage on the flight.
Status Code - A one letter code identifying the type of traveler being reported. The codes are:
C= Contractor
O= Other Official Traveler (employee)
M = Military
N= Non-Federal official
E = Senior Executive Branch official
D= Dependent
S= Senior Federal official
17.Purpose of Travel - A two-character alphanumeric code identifying the reason the passenger is traveling.
"Mission Requirement". Activities that constitute the discharge of an agency's official responsibilities. Such activities
include, but are not limited to, the transport and/or equipment, training, evacuation (including medical evacuation),
intelligence and counter-narcotics activities, search and rescue, etceteras.
1E = Emergency means an unexpected, serious occurrence or situation urgently requiring prompt action.
1O = Operational
1T = Training
"Required Use". Use of a Government aircraft for the travel of an Executive agency officer or employee to meet bona fide
communications or security requirements of the agency or exceptional scheduling requirements.
2B = Business Only
2C = Combined Business and Personal or Political (Reimbursable category)
2W = Wholly Personal or Political (Reimbursable category)
"Other Official Travel". Travel is for official business other than Mission or Required Use.
3B = Business Only
3C = Combined Business and Political (Reimbursable category)
"Space Available". Travel other than for the conduct of agency business; using aircraft capacity that is already
scheduled for use for an official purpose but would otherwise be utilized.
4S = Space Available (Reimbursable category)
18.
19a.
19b.
19c.
20.
Leg On and Leg Off - The airport name at which a passenger boarded and departed the flight.
Government Cost - The appropriate share of the full operating cost of the aircraft allocated to the traveler.
Charter Cost - The appropriate share of the full charter cost quoted by an FAA approved vendor for the planned flight.
Commercial Cost - The corresponding commercial cost had the traveler used scheduled airline service.
Reimbursement Amount - The amount required to be reimbursed to the Government for the flight, if applicable.
*Optional field supporting the automated calculations in block 19.
GSA
FORM3641 (8-95)BACK
