Form Link, Living Quarters Allowance (DSSR ) Worksheet (fillable pdf version ). Purpose. This form is to provide domicile and family member information as. Privacy Act Statement: Solicitation of this information is authorized under 5 U.S.C. , E.O. and E.O Section 1(b-2) and DSSR Section. The. DSSR EPUB – Page 1. Page 2. Privacy Act Statement: Solicitation of this information is authorized under 5 U.S.C., E.O. and E.O Section 1(b-2) and DSSR .

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List authorized family member s who do not reside with you in permanent quarters. Purpose This form is to provide domicile and family member information as well as living quarters cost estimates for effecting Living Quarters Allowance LQA payments. This form is to provide domicile and family member information as well as living quarters cost estimates for effecting Living Quarters Allowance LQA payments.

If more than one conversion rate has been used during the period, an average conversion rate shall be used for the reconciliation. Army, Air Force, Navy.

Block 7 Family Domiciled at Post: Employees in this Pay Band who have 15 years of U. Foreign Per Dssr Rates. Army, Air Force, Navy. Employees in quarters group 1 are authorized to be granted up to a maximum of twice the primary “WF” LQA rates prescribed for quarters group 2 for their post if without family or with only one family ddsr, or up to twice the otherwise applicable rate for employees with more than one family member.

Chief of Mission 22 U.

It is further used to provide actual costs for reconciliation of LQA expenditures. Block 15 Leave blank.

U.S. Department of State

Block 18 Leave blank. Block 1 Employees Name: Sign and date the form in Block Employees in Quarters Group 1. Where the couple has no additional members of family each employee may be granted the “without family” rate.

The LQA grant to any employee not paid under Section Special Instructions for Completing this Form. A repayment 13 shall be executed by the employee to enable dsst of unjustified disbursements during the annual period.

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When quarters occupied by an employee are owned by the employee or the spouse, or both, or by the employee or the domestic partner, or both, an amount up to 10 percent of original purchase price converted to U. Thereafter, each employee shall show the actual annual expenses of rent and utilities, supported by receipts or other satisfactory evidence, whenever requested by the officer designated to grant allowances, the Department of State, or other responsible authority.

Don’t list subordinate commands. An “Actual” election is normally utilized during annual reconciliations. Block 8 Family Domiciled away from Post: LQA grants for all employees shall be appropriately revised, if required, as of the following dates: No employee shall be granted more than one initial repairs allowance during a period of continuous assignment to a post. The deputy chief of mission, the principal officer of a consular establishment, and the officer at a diplomatic establishment excluding AID, unless specifically designated who is the highest ranking diplomatic or consular officer eligible to take charge in the absence of the chief of mission and the deputy chief of mission, are in the primary quarters group 2 “WF” classification for living quarters allowance regardless of their respective personnel classification or family status but are eligible for additional LQA in accordance with Section The following rates of quarters allowances may be granted to married couple employees or domestic partnership employees residing together: Enter your name Last, First, MI.

Deputy chiefs of diplomatic missions, counselors of diplomatic missions and principal officers of consular establishments may be reimbursed for their allowable quarters costs up to 50 percent more than the LQA prescribed for group 2 for the primary “WF” rate for their posts when, in the opinion of the chief of mission, the otherwise applicable LQA rate is insufficient to obtain quarters suitable for providing official entertainment required by the position occupied by such officer.

Government service may be placed in quarters group 3 at the discretion of head of agency. In determining the increment for additional family dssr both employees should be excluded. An “Estimate” election represents an initial authorization request.

Rates so obtained for the living quarters allowance are maximum and the employee receives either the maximum rate or the amount of allowable expenses, whichever is lower. Excel Versions of Per Diem. To prevent excessive in-pocket amounts during the annual period, the payments to employee shall not exceed percent of employee’s initial estimates for annual allowable expenses within the maximum rate.

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Enter current Post and Country of Assignment.

In situations where excessive fluctuations dsr utilities or other allowable 1130 costs are occurring and initial estimates for them are difficult, the annual LQA for the post, as indicated in Sections and may be granted in even amounts throughout an annual period up to but not including the last pay period thereof. At posts where there is established a duly constituted U. Despite the provisions of Sections The annual period shall be bounded either by the end of the reporting period specified in Sections The allowance is not designed to cover redecoration, repair, renovation dsssr replacement of furnishings, erection of additions to any structure or of garages, or the removal of garages or other outbuildings or improvement of grounds.

The LQA rates are designed to cover substantially all of the average employee’s costs for rent, heat, light, fuel, gas, electricity, water, taxes levied by the local government and required by law or custom to be paid by the lessee, insurance required by local law to be paid by the lessee, and agent’s fee required by law or custom to be 10 by lessee.

Rates for Senior Employees in Dssr 4. Enter your agency example: The amount of the rental portion of the allowance up to 10 percent of purchase dssr is limited to a period not to exceed ten years at which rssr the employee dssr be entitled only to above utility expenses, garbage and trash disposal, plus land rent.

List authorized family member s who reside dxsr you in permanent quarters. Enter your current Pay Plan i.