NSSC Extended TDY Questionnaire * indicates a required field All fields are required unless otherwise stated. Please do not include any Personal Identifiable Information (PII) such as Social Security number etc. If required, please submit information via postal mail to: NASA Shared Services Center Building 1111, Jerry Hlass Road Stennis Space Center, MS 39529 Never include sensitive or personal information like your Social Security number as e-mail isn’t necessarily secure. Use postal mail for sensitive or personal information. Traveler InformationDuty Station:*NASA HeadquartersAmes Research CenterArmstrong Flight Research CenterGlenn Research CenterGoddard Space Flight CenterJohnson Space CenterKennedy Space CenterLangely Research CenterMarshall Space Flight CenterNASA Shared Services CenterOffice of the Inspector GeneralStennis Space CenterOther (Please specify)Other (Please specify):Traveler Name:* First Last Traveler Phone Number:*Traveler Email:* Street Address*Address Line 2*City*State*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaFederated States of MicronesiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMarshall IslandsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOCONUS OverseasOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP Code*Preparer InformationIs preparer different than traveler?*YesNoPreparer Name* First Last Preparer Phone*Preparer Email* Travel InformationAnticipated mode of transportation from current Duty Station to ETDY Location?*AirRailBusPOV (Privately Owned Vehicle)OtherOther*Anticipated Lodging arrangements?*Long Term Lodging (Schedule 48)One Bedroom ApartmentOtherOther Anticipated Lodging Arrangements?*Anticipated method of daily transportation at ETDY?*Rental Car (non Metro Area)Metro (Metro Area)POV (Privately Owned Vehicle)OtherOther Anticipated Transportation Method?*Has traveler been on ETDY to this location before?*YesNoPrevious Travel Start Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202620252024Previous Travel End Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202620252024Will there be any family members going with you on EDTY?*YesNoFamily Member 1 First Last Family Member 2 First Last Family Member 3 First Last Family Member 4 First Last Is your spouse a government employee on ETDY or Change of Station (COS) orders?*YesNoSpouses Agency Employed Through?Do you plan on shipping items?YesNoDo you anticipate any foreign travel?*YesNoTravel Start Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202620252024Travel End Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202620252024Business Start Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202620252024Business End Date:*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202620252024Leaving From:CenterCityStateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaFederated States of MicronesiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMarshall IslandsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOCONUS OverseasOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingExtended TDY Location:CenterCityStateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaFederated States of MicronesiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMarshall IslandsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOCONUS OverseasOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAnticipated Number of Trips Home (NTE 1 per month);?*Please enter a number greater than or equal to 1.Purpose:*Do you have a Government issued Credit Card?*YesNoTravel Card APC ListWill the assignment last greater than 180 days?*YesNoIs Officials in Charge/Center Approval ready/started for assignment over 180 days?*YesNoIf you were to relocate to the new location:Do you have a spouse or domestic partner?YesNoWill they be travelling with you or separately?WithSeaparatelyDo you have dependents relocating with you?YesNoNumber of dependents under 12 years of age:Number of dependents over 12 years of age:Would you request a Househunting Trip to be authorized?YesNo*Note, cannot be allowed if already residing at TDY, such as ETDY.Would you request Temporary Quarters at the new duty station?YesNoHow many days of Temporary Quarters would you request (NTE 60)?Do you own a house at your current Permanent Duty Station (PDS)?YesNoWould you sell your residence at your PDS?YesNoIf you would not sell you home, would you utilize a licensed Property Management Company for your residence as a rental property?YesNoNumber of rooms in your current Residence?1234567891011121314151617181920Estimated weight of Household Goods:Please enter a number from 1500 to 2900.Estimated weight of Household Goods:Please enter a number from 3000 to 4499.Estimated weight of Household Goods:Please enter a number greater than or equal to 4500.Counseling InformationWhat is traveler's preferred counseling date and time?*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202620252024Time* Hours : Minutes AM PM AM/PM Traveler's preferred counseling method:*Video CallTelephone CallPlease allow at least 48 hours to prepare the proper documentation.Additional CommentsRemarks (Optional; Please Limit to 1000 characters.):AttachmentsAttachments Cannot Exceed 18 Megabytes. DO NOT UPLOAD AN ATTACHMENT UNLESS YOU ARE READY TO SUBMIT TO NSSC.Attachment: Drop files here or Select files Max. file size: 18 MB. Files are not uploaded until the trash bin (delete) button appears next to the filename.Upon completion of the Extended TDY Questionnaire, the NSSC will provide the traveler/preparer with information on accessing Extended TDY Assistance training located in SATERN. After the traveler/preparer completes the training, the NSSC will schedule one-on-one assistance.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
