Form DOE F 551.1 DOE F 551.1 U S Department of Energy Request for Approval of Foreign

DOE F 551.1 (08-02)
Replaces DOE F 1512.1
All Other Editions Are Obsolete

OMB Control No. __________________

U.S. DEPARTMENT OF ENERGY

REQUEST FOR APPROVAL OF FOREIGN TRAVEL
This form is provided as a convenience for the collection of Foreign Travel Request data. The form is intended for use as an outline resource to
collect data necessary to support the Foreign Travel Management System (FTMS). Completion of the form is not considered sufficient in itself for
satisfying DOE Order 551.1A, the data must still be entered into the FTMS for U.S. Department of Energy (DOE) tracking and monitoring. Specific
question on Foreign Travel or the completion of this form should be directed to your sites Senior FTMS Organizational Point of Contact (Sr. OPOC).
OMB Burden Disclosure Statement
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to Office of the Chief Information Officer, Records Management Division, IM-11, Paperwork Reduction Project (1910-XXXX), U.S.
Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA,
Paperwork Reduction Project (1910-XXXX), Washington, DC 20503
Section I - Traveler Information
Section I. – Traveler Information. (To Be Completed by Traveler.)
1. Name (Last, First, Middle)

2. Do you have a Social Security
Number? ( ) No ( ) Yes, please
specify.

3. Passport Number

4. Birth Date (MO-DD-YYYY)

3a. Passport Expiration Date (MO-DD-YYYY)

5. Birth Place (City, State/Province, Country)

6. Citizenship
a)
b)

7. DOE Facility/Organization

8. Employee Type
( ) DOE Federal Employee ( ) Other Federal Employee
( ) Contractor ( ) Foreign National ( ) University
( ) Invitational Traveler
Specify name of contractor or university:

9. Employee Address:
Street Address: _________________________________________________________________________________________________
City: ___________________________________________ State:_______________________ Zip: ________________ County: ____________
10. Contact Information

Work Phone: _________________________________________________________________
Work Fax: ___________________________________________________________________
Home Telephone: _____________________________________________________________
E-Mail Address:_______________________________________________________________
(required)

11. Position/Title

12a. Indicate whether you have held a DOE security clearance within the last 5 years. If yes, indicate the highest level received. ( ) Yes, please
specify ( ) Top Secret ( ) Secret ( ) Q ( ) L () No

12b. Indicate whether you have held any other security clearance within the last 5 years. If yes, enter agency and clearance level ( ) Yes, please
specify Agency: Clearance: () No

13. Notes

DOE F 551.1
(08-02)
Replaces DOE F 1512.1
All Other Editions Are Obsolete

OMB Control No._______

U.S. DEPARTMENT OF ENERGY

REQUEST FOR APPROVAL OF FOREIGN TRAVEL
(CONTINUED)
Traveler Name: _________________________________________________________________________________________________________
Section II – General Trip Information
Section II. – General Trip Information. (To Be Completed by Traveler.) Use additional general trip information pages as required. Account for all
funding types estimated for this trip request.
15. Departure Date
(MO/DD/YYYY)

14. Place of Departure (City, State/Province, Country)

16. Return Date
(MO/DD/YYYY)

17. Estimated Travel Costs by Funding Type. (One primary sponsor required)
Primary
Sponsor

Funding Type

( ) Yes

( ) DOE
( ) Non-DOD
( ) Foreign

( ) Yes

( ) DOE
( ) Non-DOD
( ) Foreign

( ) Yes

( ) DOE
( ) Non-DOD
( ) Foreign

( ) Yes

( ) DOE
( ) Non-DOD
( ) Foreign

( ) Yes

( ) DOE
( ) Non-DOD
( ) Foreign

Program
Office

Funding
Code(s)

Title

18. Flight Information
( ) Coach
( ) Premium, please provide justification:
________________________________________________________________________________________
19. Names and Organizations of Headquarters personnel with who trip has been coordinated.

20. Names and Organizations of other personnel with whom you are traveling as a team.

21. Benefit to Government (include benefit to present position and the Department)

22. Comments
(Justification statement for trips that are exceptions)

Estimated
Airfare

Estimated
Other

DOE F 551.1
(08-02)
Replaces DOE F 1512.1
All Other Editions Are Obsolete

OMB Control No._______

U.S. DEPARTMENT OF ENERGY

REQUEST FOR APPROVAL OF FOREIGN TRAVEL
(CONTINUED)
Traveler Name: _________________________________________________________________________________________________________
Section II – General Trip Information
22. Comments, cont.
Specify any paper attachments to this form

General comments regarding this trip request

Place of return, if not same as departure city and reason

DOE F 551.1
(08-02)
Replaces DOE F 1512.1
All Other Editions Are Obsolete

OMB Control No._______

U.S. DEPARTMENT OF ENERGY

REQUEST FOR APPROVAL OF FOREIGN TRAVEL
(CONTINUED)
Traveler Name: _________________________________________________________________________________________________________

Section III Trip Itinerary
Section III. – Trip Itinerary. (To Be Completed by Traveler.) Use additional itinerary pages as required. Account for the entire time between departure and
return. Complete a separate itinerary for each city/country to be visited and for each personal or leave period.
23. ( ) Yes ( ) No, Is this part of the trip associated with a conference? If yes, specify conference name, sponsor, and contact information
(i.e., URL or email address).
Conference Name: _______________________________________________________________
Sponsor Name: __________________________________________________________________
End Date: Country – City: __________________________________________________________
URL: ___________________________________________________________________________

24. Destination (Country, City)

25. Start Date (MO/DD/YYYY)

26. End Date (MO/DD/YYYY)
27. Select One or More Primary Purpose(s)
( ) Professional conference, seminar, workshop, working group, or colloquia
( ) Research and Development activities under an informal, lab-to-lab, or government-to-government agreement
( ) Meeting(s) on scientific, technical, project or programmatic matters
( ) Procurement-related matters
( ) Other(s), please specify
28. Technical Justification

This part of the trip involves:
29. ( ) Yes ( ) No
Lab-to-Lab agreement?
30. ( ) Yes ( ) No
International agreement? If Yes, Please Specify ___________________________________________________________
31. ( ) Yes ( ) No
Will classified information be discussed? Y/N
32. ( ) Yes ( ) No
Will classified information be hand carried? Y/N
33. ( ) Yes ( ) No
Will foreign intelligence information be hand carried? Y/N
34. ( ) Yes ( ) No
Will any part of the trip discuss sensitive topics as defined by DOE’s Sensitive Subject List? Y/N
35. ( ) Yes ( ) No
Will any part of the trip involve information that is subject to U.S. Export Control restrictions? Y/N
36. ( ) Yes ( ) No
Meetings with senior government official(s)?
Please provide official’s name, position, and contact information. Describe meeting goals.
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
37. ( ) Yes ( ) No

Embassy assistance will be required? Please specify.
__________________________________________________________________________________________________________
___________________________________________________________________________________________________________

38. Contact Information (required)
Host Information

After Hours

Name:

Phone: ________________________________

Affiliated Institution:

Facility to be Visited: _____________________

Name:: __________________________________________________ Phone: _________________________________

DOE F 551.1
(08-02)
Replaces DOE F 1512.1
All Other Editions Are Obsolete

OMB Control No._______

U.S. DEPARTMENT OF ENERGY

REQUEST FOR APPROVAL OF FOREIGN TRAVEL
(CONTINUED)
Traveler Name: _________________________________________________________________________________________________________

Reviews and Approvals
1.

Local Approver

______________________
Name (Type or Printed)

______________
Title

__________________
Organization

_________________________
Signature

____________________
Date
(MO-DD-YYYY)

Comments:
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
2.

Local Approver

______________________
Name (Type or Printed)

______________
Title

__________________
Organization

_________________________
Signature

____________________
Date
(MO-DD-YYYY)

Comments:
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
3.

Local Approver

______________________
Name (Type or Printed)

______________
Title

__________________
Organization

_________________________
Signature

____________________
Date
(MO-DD-YYYY)

Comments:
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
4.

Local Approver

______________________
Name (Type or Printed)

______________
Title

__________________
Organization

_________________________
Signature

____________________
Date
(MO-DD-YYYY)

Comments:
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
5.

Local Approver

______________________
Name (Type or Printed)

______________
Title

__________________
Organization

_________________________
Signature

____________________
Date
(MO-DD-YYYY)

Comments:
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
6.

Local Approver

______________________
Name (Type or Printed)

______________
Title

__________________
Organization

_________________________
Signature

____________________
Date
(MO-DD-YYYY)

Comments:
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________