| Part I. Traveler Information and Scope of Travel |
| Full Name | Office (e.g., EOUSA, USAO-ALN, etc.) |
| USAO-SDNY |
| Position Title | E-mail Address |
| AUSA | |
| Telephone Number | Departure Address(City and State) |
| New York, New York |
| Departure Date(from Home or Office) | Return Date(to Home or Office) |
| 02/03/2020 | 02/07/2020 |
| Country of Birth | USA | Place of Birth | TX, USA |
| Foreign Locations | City | Province(if applicable) | Country |
| Destination 1 | Stockholm | | Sweden |
| Destination 2 | | | |
| Destination 3 | | | |
| Destination 4 | | | |
| Q1: Are you traveling to more than four destinations? If yes, attach an additional sheet listing the additional destinations. | ○ YES | ● NO |
| Q2: Have you completed your travel reservations? If yes, please attach a detailed flight itinerary, your lodging information, and any other transportation reservations. If no, please STOP and make your travel reservations before proceeding. | ○ YES | ○ NO |
| Q3: Have you already obtained OIA's approval? If yes, please attach OIA's approval e-mail. If you are traveling for civil purposes, you do not need OIA's approval to travel. For others, submit a completed questionnaire to OIA to obtain approval. | ○ YES | ● NO |
| Q4: Do you have an official passport that is valid for at least six months from the date you will arrive in the foreign country? | ● YES | ○ NO |
| Q5: Have you submitted a request for an official passport to EOUSA and is the request currently pending? | ○ YES | ● NO |
| Q6: Has the Department of State granted you a waiver of the requirement for an official passport? If yes, please attach the State Department's e-mail granting a waiver. | ○ YES | ● NO |
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| Q7: Do any of your destinations require a visa for travel under an official passport? If applicable, submit the required materials to EOUSA to obtain visas prior to departure. | ○ YES | ○ NO |
| Q8: For the passport under which you will be traveling, please provide the following data: |
| Passport Type (e.g., Tourist, Official) | Passport Issuing Country | Passport Number(note pending, if applicable) | Passport Expiration Date(note pending, if applicable) |
| Official | USA | | |
| Q9: Are you traveling to a high-threat area? | ○ YES | ○ NO | |
| Q10: Have you completed HTSOS training in the last five years? If yes, please attach the training certificate if you are traveling to a high-threat area. | ○ YES | ○ NO | |
| Q11: Have you completed FACT training in the last five years? If yes, please attach the training certificate, if you are traveling to a high-threat area. | ○ YES | ○ NO | |
| Q12: What is your security clearance level? If you have access to TS-SCI, you must complete a DOJ-504 and provide it to your DOSM and receive a security briefing prior to departure. | Secret Top SecretTS-SCI Other |
| Q13: Do you plan to take any government-furnished equipment(including“bring your own device” equipment) out of U.S. territory? If yes, submit a request to your IT Systems Manager. | ○ YES | ○ NO | |
| Q14: Will any travel expenses be paid for, or reimbursed, by a source external to the EOUSA/USAO community? If yes, seek advance approval from GCO or RMP, as necessary. | ○ YES | ○ NO | |
| Q15: Do your travel arrangements include actual lodging expenses(i.e., lodging expenses in excess of OCONUS rates)? | ○ YES | ○ NO | |
| Q16: Do your travel arrangements include premium class travel(e.g., travel accommodations above coach class)? | ○ YES | ○ NO | |
| Q17: Have you already received country clearance from the State Department through the eCC system? If yes, please attach the eCC notification that provides country clearance. | ○ YES | ○ NO | |
| Q18: EOUSA requests eCC country clearance for nearly all EOUSA and USAO travelers.The clearance is required prior to departure.Shall EOUSA request eCC clearance for you? | ○ YES | ○ NO | |
| Q19: If you do not have eCC authorization to travel,and you do not want EOUSA to request eCC clearance for you,what office is requesting eCC clearance on your behalf?Note that federal investigative agencies are not authorized to obtain eCC clearance on behalf of EOUSA or USAO attorneys. | |
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| Part II. General Questions Applicable to All Foreign Travel |
| Q20: Who is paying for the travel? |
| USAO- SDNY |
| Q21: If foreign embassy personnel or consular or diplomatic officials have been consulted regarding travel, please provide their names, titles, organizations and contact information. |
| N/A |
| Q22: If U.S. Embassy or consular personnel have been involved, please provide their names, titles, section, and contact information. |
| N/A |
| Q23: If assistance from U.S. Embassy or consular personnel is required (e.g., a consular official to administer an oath) or if office space at an Embassy or consulate is required, please specify. If the Embassy is coordinating lodging, please include your credit card information. |
| N/A |
| Q24: If the assistance of a stenographer, court reporter, interpreter, or other service provider is required in the foreign country, please provide specific details about when and where services are required. EOUSA will relay the request to the State Department in the eCC system. |
| N/A |
| Q25: Please include any other comments or details that would help the Department of State ensure that difficulties do not arise. |
| N/A |
| Q26: I am traveling... |
| ○ Abroad to Attend a Conference or Training Event(Complete Part III) |
| ● To a Country Other Than Canada on a Judicial Assistance Matter(Complete Part IV) |
| ○ To Canada on a Judicial Assistance Matter(Complete Part V) |
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