Aug 1, 1975 ... REQUEST AND AUTHORITY FOR LEAVE. This form is subject to the Privacy Act of 1974. For use of this form, see AR 600-8-10. The proponent...
DA Form 2166-9 Series Module 3: NCOER Support Form & Grade Plate NCOERs as of 10 July 2015
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12 Unclassified Check on Learning 1. The DA Form 2166-9 Series is comprised of one support form and three grade plate NCOERs. True or False? 2
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1. CONTROL NUMBER
REQUEST AND AUTHORITY FOR LEAVE This form is subject to the Privacy Act of 1974. For use of this form, see AR 600-8-10. The proponent agency is ODCSPER. (See Instructions on Reverse)
PART - I 3. SSN
2. NAME (Last, First, Middle Initial) 6. LEAVE ADDRESS (Street, City, State, ZIP Code and Phone No.)
DEPARTURE c. NAME/TITLE/SIGNATURE OF DEPARTURE AUTHORITY
15. a. NUMBER DAYS
b. DATE APPROVED
EXTENSION c. NAME/TITLE/SIGNATURE OF APPROVAL AUTHORITY
16. a. DATE
b. TIME
RETURN c. NAME/TITLE/SIGNATURE OF RETURN AUTHORITY
17. REMARKS
This form is provided courtesy of armyproperty.com
Chargeable leave is from
to
PART II - EMERGENCY LEAVE TRANSPORTATION AND TRAVEL 18. You are authorized to proceed on official travel in connection with emergency leave and upon completion of your leave and travel will return to home station (or location) designated by military orders. You are directed to report to the Aerial Port of Embarkation (APOE) for onward movement to the authorized international airport designated in your travel documents. All additional travel is chargeable to leave. Do not depart the installation without reservations or tickets for authorized space required transportation. File a no-pay travel voucher with a copy of your travel documents or boarding pass within 5 working days after your return. Submit request for leave extensions to your commander. The American Red Cross can assist you in notifying your commander of your request for extension of leave. 19. INSTRUCTIONS FOR SCHEDULING RETURN TRANSPORTATION:
For return military travel reservations in CONUS call the MAC Passenger Reservation Center (PRC): Should you require other assistance call PAP: 20. DEPARTED UNIT 21. ARRIVED APOD 22. ARRIVED APOE (return only) 24.
23. ARRIVED HOME UNIT
PART III - DEPENDENT TRAVEL AUTHORIZATION
25.
(Space available or required cash reimbursable) ONE WAY ROUND TRIP (Space required) TRANSPORTATION AUTHORIZED FOR DEPENDENTS LISTED IN BLOCK NO. 25 DEPENDENT INFORMATION b. RELATIONSHIP d. PASSPORT NUMBER a. DEPENDENTS (Last name, First, MI) c. DATES OF BIRTH (Children)
PART IV - AUTHENTICATION FOR TRAVEL AUTHORIZATION 26. DESIGNATION AND LOCATION OF HEADQUARTERS
28. DATE ISSUED
29. TRAVEL ORDER NUMBER
DA FORM 31, SEP 93
27. ACCOUNTING CITATION
30. ORDER AUTHORIZING OFFICIAL (Title and signature) OR AUTHENTICATION EDITION OF 1 AUG 75 IS OBSOLETE