Privacy Act statement
Basic authority in 5 USC 5701-5733, 20 USC 905, and Executive Order 9397, as amended. The form says disclosure is voluntary, but that expenses cannot be reimbursed without the information.
GSA2255
Service Agreement and Duplicate Reimbursement Disclosure Statement - Moving Expense Allowances (Within the United States and Return From Foreign Post)
- Agency
- GSA
- Revision
- Rev. 6/2012
- Fillable fields
- 32
- Pages
- 1
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 2255: Service Agreement and Duplicate Reimbursement Disclosure Statement
GSA Form 2255, Service Agreement and Duplicate Reimbursement Disclosure Statement, Moving Expense Allowances (Within the United States and Return From Foreign Post), is a one-page General Services Administration (GSA) form, printed as GSA 2255 (REV. 6/2012). GSA hosts it in its forms library, and GSA's page lists PFM P 4290.1 as its authority or regulation.
The form says this document establishes eligibility for payment of travel, transportation, and other moving expenses authorized by 5 U.S.C. 5723, 5724, and 5724a. The employee lists the gaining service or staff office, the title and grade of the new position, the effective date of the transfer or appointment, the residence address at that time and the dependents authorized to relocate.
The employee then agrees to remain in the service of the Government for 12 months after reporting for duty at the new official station, states that no duplicate reimbursement for relocation expenses has been or will be accepted, and signs. You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 2255
Items 1 to 4: position and transfer
Gaining service or staff office, title and grade of the position to be occupied, effective date of transfer or appointment, and residence address at that time.
Item 5: dependents
A grid for the names of dependents authorized to relocate.
Service agreement
A pledge to remain in the service of the Government for 12 months after reporting for duty at the new official station shown on GSA Form 87 and GSA Form 87A, unless separated for reasons beyond the employee's control that are acceptable to the department concerned.
Duplicate reimbursement and temporary quarters
A statement that the employee and immediate family have not accepted, and will not accept, duplicate reimbursement for relocation expenses, and a certification about the lump sum method for temporary quarters expenses.
RIT Allowance and signature
An agreement to submit certified tax information and an SF 1012, Travel Voucher, for the RIT Allowance within 90 days, then the employee's signature in item 6 and the date in item 7.
How to complete GSA Form 2255
- 1
Enter the position details
Fill in the gaining service or staff office, the title and grade of the position, the effective date and the residence address in items 1 to 4.
- 2
List the dependents
Enter the names of dependents authorized to relocate in the item 5 grid.
- 3
Write your name in the agreement
Enter your name on the blank line that opens the service agreement.
- 4
Read the agreement statements
They cover the 12-month service agreement, duplicate reimbursement, temporary quarters and the RIT Allowance. The form says that if the agreement is violated, moving expenses paid by the United States are considered a debt due to the United States.
- 5
Sign and date
Sign item 6, Signature of Employee, and enter the date in item 7.
- 6
Keep the RIT Allowance deadline in view
The agreement covers submitting certified tax information and a properly executed SF 1012 within 90 days after receipt of official notice of eligibility from the Region 6, Financial and Payroll Services Division.
Why fill Form GSA2255 on indox
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- Fill the form right in your browser, no software to install
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- The official blank straight from the GSA, not a copy someone retyped
- Works on a phone, tablet or computer
Routing and what the form says
Where it goes
The form prints no address or routing instructions. It refers to the gaining service or staff office in item 1 and to GSA Form 87 and GSA Form 87A for the new official station.
Time periods printed on the form
12 months of Government service following the date of reporting for duty at the new official station, and 90 days after the official notice of eligibility for the RIT Allowance paperwork.
If the agreement is violated
The form says monies spent by the United States on travel, transportation and related moving expenses for the employee and immediate family are then considered a debt due to the United States.
Payroll deductions
The form says payroll deductions will be taken each pay period, in accordance with the Debt Collection Improvement Act of 1996 (DCIA), to recover any Withholding Tax Allowance (WTA) owed because the required information was not submitted.
Privacy
The Privacy Act statement says the purpose is to determine eligibility for and the amount of reimbursement for permanent change of duty station travel, and that information may be transferred to Federal, State, or local agencies for civil, criminal, or regulatory investigations or prosecutions.
Related forms
GSA87
Official Travel Authorization
89 fields, 2 pages
GSA87A
Official Change of Duty Station Authorization
293 fields, 2 pages
OF1012
Travel Voucher
315 fields, 2 pages
GSA2494
Claim for Reimbursement of Closing Costs for Sale of Old Residence
53 fields, 1 page
GSA2494A
Claim for Reimbursement of Closing Costs for Purchase of New Residence
233 fields, 4 pages
GSA2485
Cost Comparison for Shipping Household Goods
80 fields, 1 page
Who fills out GSA Form 2255?
The form is a statement signed by the employee. It names these people and offices.
Official sources and the blank
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Questions about Form GSA2255
Who issues GSA Form 2255?
The footer reads GENERAL SERVICES ADMINISTRATION and GSA 2255 (REV. 6/2012). GSA hosts it in its forms library, and GSA's page lists PFM P 4290.1 as its authority or regulation.
How long does the service agreement last?
The form says the employee agrees to remain in the service of the Government for 12 months following the date of reporting for duty at the new official station, unless separated for reasons beyond the employee's control that are acceptable to the department concerned.
What happens if the agreement is broken?
The form says any monies spent by the United States on travel, transportation and related moving expenses for the employee and immediate family under sections 5723, 5724, and 5724a of Title 5 of the United States Code are then considered a debt due to the United States.
What does the form say about duplicate reimbursement?
The employee states that they and their immediate family members have not accepted, and will not accept, duplicate reimbursement for relocation expenses from public or private sources, and that to the best of their knowledge no third party has.
What other forms does GSA Form 2255 mention?
GSA Form 87, Official TDY Travel Authorization, and GSA Form 87A, Official Change of Duty Station Authorization, for the new official station, and SF 1012, Travel Voucher, for the Relocation Income Tax Allowance.
Is giving the information voluntary?
The Privacy Act statement says disclosure is voluntary and there is no personal liability for not furnishing the information, but that expenses cannot be reimbursed without it.