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Dd Form 1351-6

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Dd Form 1351-6
Dd Form 1351-6
MULTIPLE PAYMENTS LIST
Page of Pages
PRIVACY ACT STATEMENT
AUTHORITY:
PRINCIPAL PURPOSE(S):
ROUTINE USE(S):
DISCLOSURE:
Title 5 USC 5516, 5517, 5520, and 5701; Title 37 USC 404-427; and E.O. 9397
Used to supplement DD Form 1351-2, "Travel Voucher or Subvoucher," to substantiate claims for reimbursement when multiple individuals of an
organization are performing official travel at the same time, between the same points, and accounting data is the same. The information collected may also
be used as a payroll list.
Information may be furnished to an employee's state and/or local taxing authorities, to comply with agreements entered into by the Secretary of the
Treasury, for verification of filing information used by an individual in a tax return; in addition, release of information on this form may be made to Federal,
state, local or foreign law enforcement agencies, for investigation of and possible prosecution of an individual charged with violating any law, statute, rule,
regulation, or order in this claim for restitution.
Voluntary; however, failure to furnish requested information may result in total or partial denial of amount claimed.
1. TYPE OF PAYMENT (Check applicable)
MILITARY PAY (MP) TRAVEL ALLOWANCE (TA) OTHER (Specify)
D.O. VOUCHER NUMBER
2. PAYROLL NUMBER (If applicable) 3. DATE OF COMPUTED PAYMENT
4. ORGANIZATION AND STATION
PAID BY
5. PAYEE IDENTIFICATION
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a. LAST b. FIRST c. MI d. SSN
e. TRAVEL ORDER
OR OTHER
AUTHORITY
f. AMOUNT
g. SIGNATURE
OR CHECK NUMBER
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PAGE TOTAL
6. ACCOUNTING CLASSIFICATION
7. PURSUANT TO AUTHORITY VESTED IN ME, I CERTIFY THESE STATEMENTS ARE CORRECT AND PROPER
a. NAME AND TITLE OF CERTIFYING OFFICER (Please type) b. CERTIFYING OFFICER (Signature)
DD FORM 1351-6, JUN 93
Replaces DD Forms 115 (MAY 74), 1351-1 (SEP 61), and 1351-6
(NOV 64), which may be used until DEC 31, 1993.
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Dd Form 1351-6