Please print the application(s) and deliver to SSgt Franklin R. Springer 799 ABS at Bldg 52, 2nd Street. The office number is (702) 404-1756

Rank
Firstname
Lastname
Email
Squadron
SrA
Kevin
Reynolds
799 Air Base Squadrib
 
After reviewing the forms, please click:

UNITED STATES AIR FORCE
OUTSIDE THE NATIONAL CAPITAL REGION
MASS TRANSPORTATION BENEFIT PROGRAM APPLICATION

Purpose: Executive Order 13150 requires Federal agencies to establish a transportation incentive program in order to reduce Federal employee contribution to traffic congestion and air pollution and to expand their commuting alternatives. The purpose of the program is to encourage commuting by mass transportation and provide incentives to members/employee.


A. Applicant Information:
Application must be filled out completely. Please print clearly as incomplete or illegible applications will not be processed. Please call 702-404-1756 or email [email protected] for any unanswered questions.
Initial Enrollment
Making a Change
Withdrawing
Name as it appears in payroll records or on paycheck:

Duty Location (City): Creech AFB                            Office Telephone Number (commercial):
Are you (check one):

Air Force Active Duty
Air National Guard Active Duty
Air Force Reserve Active Duty

Air Force Civilian Employee
Air National Guard Civilian Employee
Air Force Reserve Civilian Employee

Air Force NAF Employee
Air National Guard NAF Employee
Air Force Reserve NAF Employee

Name of the transportation system/company used:            FedVan            

Vanpool Lead (Primary Driver Rank/First & Last name): __________________________________________________________

If you are a van pool member, please complete the supplemental application. The supplemental application must list each van pool member (minimum requirement of 5 registered members for van pool; vehicle must be used 50 percent for commercial van pool)


B. Employee Certification:

WARNING: This certification concerns a matter with the jurisdiction of an agency of the United States and making a false, fictitious, or fraudulent certification may render the maker subject to criminal prosecution under Title 18, United States Code, Section 1001, Civil Penalty Action, providing for administrative recoveries of up to $10,000 per violation, and/or agency disciplinary actions up to and including dismissal.

                I certify that I am eligible for a public transportation fare benefit, will use it for my daily commute to and from work, and will
                not transfer it to anyone else.
                I certify that the monthly transit benefit I am receiving does not exceed my monthly commuting costs.
                I certify that my usual monthly commuting costs are: $
                I certify that this information is accurate and agree to notify the installations POC of any change to employee status:
                [Note: The current maximum benefit amount available to Air Force employees is $260.00 a month].
                Please indicate your estimated transportation cost above. Benefits will be paid in the form of TransVerse debit card.

 

 


C. Installation Point of Contact:

Unit Address:                    Bldg 52, 2nd Street                               Phone:              (702) 404-1756       

PRIVACY ACT STATEMENT: This information is solicited under authority of Public Law 101-509. Furnishing the information on this form is voluntary, but failure to do so may result in disapproval of your request for the mass transportation fringe benefit. The purpose of this information is to facilitate timely processing of your request, to ensure your eligibility, and to prevent misuse of the funds involved. This information will be matched with lists at other Federal agencies to ensure that you are not listed as a carpool or vanpool participant or a holder of any other form of vehicle worksite parking permit with DoD or any other Federal agency. Partial social security number (SSN - last four numbers) will be used for record keeping purposes.

MASS TRANSPORTATION BENEFIT PROGRAM
RIDERSHIP POLICY
Purpose: This instruction prescribes policies and procedures for all individuals involved in the Mass Transportation Benefit Program (MTBP) per NELLISAFBI36-3901 27 OCT 16

Procedures: All riders participating in the program will comply with the following procedures:


1. Individual rider participation will be set at a minimum of 50% of each work month, which equates to 10 workdays, to and from work. Individuals will be removed from the program if they fail to meet the minimum ridership participation without providing a valid excuse.


2. IAW Department of the Air Force TIP policies, transit subsidy is a benefit to cover transportation costs actually incurred and it is not designed to be paid as a means of reserving or "holding" vanpool seats. Transit subsidy cannot be claimed or used by the rider to preserve a seat, even if the rider is away due to official TDY. Rider must cover the cost personally, or will resign from the program.


3. A medical leave policy is in effect for vanpool riders if they, or an immediate family member, has a medical situation. Rider's seat will be held for up to 30 days. Rider will inform 799 ABG MTBP Manager, vanpool coordinator and approved vanpool provider of any medical leave, explaining the circumstances, and will also provide an estimated leave of absence.


4. A military TDY/deployment policy is in effect for vanpool riders if they are TDY/deployed for up to 30 days. A seat will be held for the rider. If a rider is TDY/deployed in excess of 30 days, they will be removed from the program and must reenroll upon their return. Rider will inform 799 ABG MTBP manager and service provider of any TDY/deployment in excess of 30 days.


5. Riders will use the service providers to the fullest extent possible. If a rider is on leave, they will be excused, but notice must be given to 799 ABG MTBP manager and service provider as to the length of the leave period.


     5.1 Riders will not substitute with driving their own vehicle. Commitment must be made to using the service provider. If it becomes known that an individual is driving themselves and not using service providers they will be removed from the program.


6. MTBP is not an entitlement to Department of Defense employees. MTBP is offered as a fringe benefit, an incentive to use alternate means of transportation that reduce road congestion and environmental impact. The Department of Transportation pays for this service and abuse of it will not be tolerated.


7. Transverse Debit cards WILL be picked up within the first 15 days of each month. Unclaimed Transverse debit cards will be returned to the Department of Transportation. Failure to pick up transverse debit cards will result in removal from the program.


Consequences: Failure to meet the standards set forth in this instruction will force immediate removal from the Transportation Incentive Program.


               Note: It is the responsibility of the participant to ensure that payments are made by the
              required date. Failure to do so can result in payment needing to be made by the participant.


I have read the Transportation Incentive Program above and understand the policies of the program as described therein.


 

 


Mass Transportation Benefit Program (MTBP)Ethics Awareness Training

Applicants and participants are required to take a brief ethics training. When applying for and claiming the benefit, participants in the program must certify and attest to program criteria. The training informs applicants/participants of important ethical conduct and legal implications associated with using the benefit.


Program Background: The MTBP was established in October 2000 and is offered to eligible* employees and military service members, to the extent authorized by law and regulation, to reduce pollution and traffic congestion, preserve the environment, and expand transportation alternatives.


Tax Evasion and Fraud: Employees who misuse the transportation benefit will be subject to criminal prosecution, and/or agency disciplinary action, up to and including dismissal. Substantiated violations of any of these certifications may impact an employee’s security clearance status.


When applying for the benefit, you will be attesting to several things. By signing, the applicant is formally and legally attesting that the statements made in the application are true. The DoD MTBP certification includes several certification statements.


The certifications state, I certify that I understand that:


1. I am employed by the US Department of Defense and am not named on a federally subsidized workplace parking permit with DoD or any other Federal Agency. If applicable, I have relinquished my workplace parking permit to the issuing authority.
This means that you do not have federally subsidized parking, are not listed on any federal parking pass and you do not park your vehicle at a government parking lot or garage.


2. My claim for benefits is as a Federal employee or military service member.
This means that you are directly employed by the DoD (and receive your pay directly from the DoD) or are an Active Duty military service member, including Reservists and National Guard Members who are on active duty for more than 30 days. Also included are part-time Federal employees, paid interns, non-appropriated fund (NAF) employees employed by a duly constituted NAFI.


3. I am eligible for a public transportation fare benefit, will use it only for my daily commute to and from work, will not transfer it to anyone else, and will not allow anyone else to use it.
This means that you are qualified to receive the transportation fare benefit, you use a qualified means of transportation to commute to/from work and you will not give or sell your benefit to anyone for any other purpose.


4. The monthly transportation benefit I am claiming does not exceed my monthly commuting costs.
This means that you will not claim more in fare benefit than what it actually costs you for your commuting to/from work. Costs should be calculated based on actual days commuted, taking into consideration telecommuting, alternate work schedules and compressed work schedules.


5. I will adjust the amount received based upon long term TDY or leave.
This means that if you are away for an extended period, in which you are not commuting and incurring costs, you will not claim benefits, or if you have already been issued benefits for that period, you will reduce your next claim by any remaining amount. Please note that the DoD does not pay to “hold” or “reserve” seats for vanpools while you are on extended absence.




6. Upon separation from DoD, I will return unused fare media to the MTBP Office. If I have converted the fare media to another form of media, I will reimburse the DoD by check or money order payable to the U.S. Treasury.
This means that you are responsible for returning any fare media or providing repayment to the DoD for periods during which you are not eligible to participate


7. I will notify the MTBP office of any changes in my status, i.e. home or work address, change in commuting pattern or change in organization even if within the DoD.
This means that you are responsible for notifying the MTBP Office of any changes that affect your home/work address, commuting pattern or change in employing organization


8. I will NOT calculate parking costs
This means that you will not include costs incurred for parking (i.e. Metro parking lots, commuter lots, parking garages, etc) when determining your monthly commuting costs. The benefit is intended to solely cover your use of mass transportation.


9. I am not a vanpool owner/driver of my own for profit vanpool. If I am a driver and receive a reduced fee, I will adjust my claim for benefits accordingly. If I am a driver and receive compensation, I may not participate in the program.
Vanpool owners who commute in their own (or their own company’s) vanpool may not receive the benefit. Furthermore, if you are a driver of a vanpool owned by another person or company and receive compensation for driving, you may not participate in the program. Finally, if you are a driver of a vanpool owned by another person or company and pay a reduced fee to the vanpool owner, you may not receive more benefit than your actual cost.


10. The mode of transportation for which I am claiming the mass transportation benefit is a qualified means of transportation.
Qualified means of transportation (QMOT) are commercial or public transportation operated for use by the general public and/or modes of transportation that meet the requirements of section 1.132-9 of title 26 of the Code of Federal Regulations (C.F.R.).




LAST, FIRST / RANK



SIGNATURE / DATE


SQUADRON


PRIMARY / VANPOOL PROVIDER

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