Part 5, Chapter 8: Manual Exhibit J

First Line Supervisor__________________________________________________

Office/Area Director__________________________________________________

Charge Card Coordinator______________________________________________

Date________________________

Information for lines 1, 2, and 3 will be typed or printed, and the individual named shall initial beside his/her name.)

1. An employee must be authorized to be issued a Government travel card by his/her Office Director or the Area Director.
2. The employee shall return the Government travel card upon separation from Indian Health Service (IHS).

1. The Government travel card shall be used only for those expenses incurred during official travel.  Such expenses include but are not limited to hotel/motel accommodations, meals, car rentals, and gasoline.
2. The Government travel card shall not be used for personal business.
3. The Government travel card is not transferable and shall be used only by the employee to whom it is issued.

1. The employee is liable for all expenses charged to his or her Government travel card account.
2. The employee shall promptly notify the Government travel card vendor if the card is lost or stolen to prevent fraudulent charges.
3. The employee shall remit payment IN FULL to the Government travel card vendor within 25 days of the billing date shown on the billing statement.  This payment shall be made regardless of whether the employee has been reimbursed by the Government for expenses.
4. If the employee is having difficulty in receiving travel reimbursement, the employee's office shall notify the Government travel card vendor of the delay in reimbursement and request that no action be taken on the account.  Immediately upon receiving reimbursement, the employee shall remit full payment to the Government travel card vendor.
5. If a bill contains a disputed charge, the employee shall contact the Government travel card vendor directly to resolve the problem.
6. The Government travel card vendor will cancel the account of any employee whose charges have not been paid within 90 days of the original billing statement.  Moreover, the employee will be held liable for all court costs and reasonable attorney fees if the Government travel card vendor must refer all or any part of the account to an outside agency for collection.
7. Any account which is canceled with more than a $100 balance and that is more than 120 days past due will be reported to credit reporting organizations by the Government travel card vendor.

1. Employees issued a Government travel card are limited to travel advances via the ATM in accordance with Area Office policy.
2. An employee whose card has been canceled/suspended for misuse or delinquency shall not be issued travel advances.
3. Employees who refuse to apply for the Government travel card shall not be issued travel advances.

I have read, understand, and agree to comply with the rules and requirements concerning the proper use of the Government travel card issued to me by the authorization and at the convenience of the Indian Health Service.  I understand that failure to comply with these and the other terms and conditions of use as established by the Government travel card vendor for the use of the charge card may result in disciplinary personnel action being taken against me.

Signature of Applicant/Cardholder_______________________________________ Date: _________________