APPLICATION FOR DO IT YOURSELF MOVE
AND COUNSELING CHECKLIST
(Read Privacy Act Statement on back before completing form.)
1.
(YYYYMMDD)
2.
3. EMPLOYEE INFORMATION
a. NAME (Last, First, Middle Initial) b. c. SSN d.
4. INCIDENT TO THE FOLLOWING ORDERS:
a. TYPE ORDERS (X one)
LOCAL
PERMANENT
TEMPORARY
b. OF ORDERS (YYYYMMDD) c. ISSUED BY
d. DUTY ASSIGNMENT e. ORDERS NO. f.
g. h. PAYING (AFO/F&AO) NAVY AND MARINE CORPS
5. CHECK TO:
(Complete address)
6. LEGAL
RESIDENCE
7. (X and complete as applicable)
a. of GBL (Van) and/or DITY move (nontemporary
storage).
b.
to
c. with accurate estimate weight of HHGs.
d.
e. items (POV's,
flammables, etc.).
f.
g.
h.
liability.
i.
8. (X and complete as applicable)
a. Operating allowance (amount):
b. Pick up rental vehicle and ensure safe operation.
Pick up date (YYYYMMDD):
c. Empty/loaded weight tickets required for each trip made.
Use government, public, commercial scales.
d. Name, rank, Social Security Number, Weighmaster's
signature required on each weight ticket.
e. Trailers weighed attached to prime mover (no passengers
aboard - weigh entire unit at same time).
f. DITY moves require DD Form 1351-2.
g. DD Form 2278 and weight tickets must be submitted to
paying office/TMO/ITO to receive incentive payment.
Provide Rental Contract (not required for Air Force and Army.)
9.
a. ESTIMATED CONSTRUCTIVE COSTS
(1) MTMC RATE SOLICITATIONS PLUS $5.00
PER CWT X EST. WT. OR WT. ALLOWANCE
(2) LOCAL RATE PER CWT X EST. WT. OR WT.
ALLOW.
(3) ESTIMATED GROSS INCENTIVE
(4) ADVANCE OPERATING ALLOWANCE
$
$
$
$
b. BY DSSN
c. VOUCHER NO. d. (YYYYMMDD)
e. days from the start
of this move. consent to collection of
all government costs of this move from my pay.
consent to collection of any unearned advance operating allowance
up to a maximum of
$
from my pay.
NO INCENTIVES WILL BE PAID WITHOUT ACCEPTABLE WEIGHT TICKETS AND OTHER REQUIRED DOCUMENTS.
10. I CERTIFY THAT I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES AND CONDITIONS PRINTED ON THIS FORM.
a. SIGNATURE OF MEMBER/AGENT b. SIGNED c. SIGNATURE OF COUNSELOR d. SIGNED
11. CERTIFICATION OF ITO/TMO
(1) RATE PER CWT
PLUS $5.00 x
=
$
ACTUAL WT. OR WT. ALLOW.
a. ACTUAL CONSTRUCTIVE COSTS
(2) LOCAL RATE PER CWT
=
$
X ACTUAL WT. OR WT. ALLOW.
b. CONSTRUCTIVE COST OF GBL OR LOCAL MOVE IS $
(Attach copies of acceptable tare and gross tickets.)
12. TMO ACCT. DATA:
a. TYPED OR PRINTED NAME b. c. DATE SIGNED
DATE PREPARED SHIPMENT NUMBER
MEMBER OR
RANK/GRADE AGENCY
THIS SHIPMENT/STORAGE IS REQUIRED
DATE
NEW NUMBER OF MILES
NAME OF PREPARING OFFICE
SEND STATE OF
ENTITLEMENTS
Option
DITY move authorized from
ITO/TMO provided
Maximum authorized weight.
Unauthorized
Power of Attorney, if required.
Type of vehicle authorized (POV).
Loss or damage - maximum government
Temporary storage.
MEMBER RESPONSIBILITY
COST COMPUTATION
PAID
DATE
I agree to furnish two weight tickets within 45
If I fail to do so, I voluntarily
I also voluntarily
DATE DATE
SIGNATURE
DD FORM 2278, SEP 1998
REPLACES AF 417, MAY 82, AND PREVIOUS
EDITIONS OF DD 2278, WHICH ARE OBSOLETE.
0.00
0.00
Reset
PRIVACY ACT STATEMENT
AUTHORITY: 37 USC 406; 5 USC 5726; and E.O. 9397.
PRINCIPAL PURPOSE(S): Primarily used as a checklist for shipment of personal property under the
Do-It-Yourself Moving Program. Use of the form ensures a Do-It-Yourself mover is familiar with required
details of the program and is used to substantiate the member's claim for incentive payment. The form is
used by finance offices to provide data for review of cases where excessive costs may have been collected
by a service member.
ROUTINE USE(S): Information will be disclosed to the General Accounting Office or to any other Federal
agency responsible for auditing public financial records for the purpose of validating agency procedures or
investigating instances of waste, fraud, and abuse. In the event an audit gives indication that any laws may
have been violated, information may be provided to Federal, state, local, and other government law
enforcement officials for investigation of suspected fraud and prosecution of individuals who investigation has
indicated should be prosecuted for fraud.
DISCLOSURE: Voluntary; however, if information is not provided, personal property cannot be moved under
the Do-It-Yourself Program.
MEMBER RESPONSIBILITY
1. This shipment/storage lot consists of my
property or the property awarded to my ex-spouse
incident to a divorce which was acquired by me
prior to the effective date of my orders.
2. If my orders are modified or cancelled and affect
this shipment, I will immediately notify the shipping
office at point of origin (or port, if any) and
destination.
3. I will remit the proper amount or consent to the
collection from my pay as may be necessary to
cover all excess costs occasioned by this shipment.
4. I agree to furnish weight tickets within 45 days
of the start of the move to preclude issuance of DD
Form 139 for collection of all charges paid by the
government.
5. I understand the government will not be
responsible for goods remaining in storage after the
expiration of the authorized period.
6. Incentives will be paid by:
NAVY - Forward documents to:
Commanding Officer
Navy Material Transportation Office
Code 024, Bldg Z-1135-5, Naval Base
Norfolk, VA 23511-6691
MARINE CORPS - Forward documents to:
Commanding General
470 MCLB
Albany, GA 31704-5000
CERTIFICATION BY MEMBER
I certify that I completed my shipment under the Do-It-Yourself Program and that my shipment consisted
of household goods and personal effects that were authorized to be moved at Government expense. These
goods belonged to me and were used by myself (or family) before the effective date of change of station
orders. I also certify that I have not received previous payments relating to this move (excluding operating or
mileage monetary in lieu of transportation for dependents).
DD FORM 2278 (BACK), SEP 1998
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome