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INSTRUCTIONS TO INDIVIDUAL
1. AUTHORITY FOR LEAVE. A Soldier on leave must carry this form while on leave.
2. CHANGES. A Soldier who desires changes in authorized leave or does not begin leave on schedule
will notify commander.
3. REPORTING. A Soldier will report to duty station not later than 2400 on the last day of leave (block
10b) (even if PCS orders contain a later reporting date).
4. DEPARTURE/RETURN. A Soldier will begin and end leave on post, at the duty location, or from the
place he or she regularly commutes to work.
5. CHARGEABLE LEAVE. If a Soldier works over one-half of the normally scheduled working hours
on the day of his or her departure or return, that day is not a chargeable leave day. (Soldier's
commander may authorize early departure or late arrival.) If he or she returns on a normally scheduled
nonduty day, that day is not chargeable to leave.
6. TRAVEL EXPENSES. A Soldier on leave pays for all his or her travel expenses, to include return to
duty station. He or she must have sufficient funds to pay all expenses. A Soldier without sufficient
funds to return to duty station reports to the nearest military installation.
7. LEAVE EXTENSIONS. A Soldier must request leave extension prior to end of leave.
8. LOST OR DESTROYED LEAVE FORM EN ROUTE PCS. Request a reconstructed form from the
losing station. Continue with required travel and reporting dates.
9. CASUAL PAY. A Soldier who needs a casual pay while on leave should contact the servicing FAO
for information and assistance.
10. MEDICAL TREATMENT.
a. A Soldier who requires medical treatment while on leave, report to the nearest military medical
facility. In the absence of such a facility, report to a uniformed services treatment facility or Veteran's
Administration facility, if possible.
b. Medical treatment at Government expense at other than federal facilities is authorized only for
emergencies when treatment cannot be obtained from Government facilities or when prior approval is
c. If a Soldier becomes hospitalized by a civilian physician, the Soldier or someone acting for him or
her contact the Patient Administration Office of the nearest military medical facility as soon as
possible. A Soldier may seek assistance from the nearest U.S. Army recruiting station or local chapter
of the American Red Cross. Information provided must include nature of illness or injury, date and
place of hospitalization, and name and telephone number of attending physician.
d. If a Soldier is placed sick-in-quarters by a civilian physician he or she will
(1) Contact the Patient Administration Office of the nearest military medical facility.
(2) Obtain written statement from attending physician (military or civilian) verifying condition and
including dates of treatment. Provide statement to leave approving authority upon return to duty.