SmartBenefits box
Current User or New User, and the SmarTrip Card Serial Number, which the form says must be registered in the employee's name.
GSA3675A
Transit Subsidy Program Application (SmartBenefits)
- Agency
- GSA
- Revision
- Rev. 3/2016
- Fillable fields
- 85
- Pages
- 3
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 3675A: Transit Subsidy Program Application (SmartBenefits)
GSA Form 3675A, Transit Subsidy Program Application (SmartBenefits), is a three-page GSA form. The footer reads GENERAL SERVICES ADMINISTRATION and GSA 3675A (REV. 3/2016), and GSA hosts it in its forms library.
The Privacy Act statement says the form is used to collect data from GSA employees applying for benefits under the Transit Subsidy Program. A SMARTBENEFITS box at the top asks whether the applicant is a current or new user and for a SmarTrip Card Serial Number, which the form says must be registered in the employee's name. Page 1 also holds the applicant information, an employee certification and signature blocks for the employee, the first level supervisor and the Transit Subsidy Coordinator. Page 2 is a monthly commuting cost worksheet with a split allocation line for a debit card and a SmarTrip card. Page 3 holds the instructions and the Privacy Act statement.
You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 3675A
Items 1 to 17: applicant information
Application type, name, home address, last 4 digits of the Social Security Number, correspondence symbol, official worksite, office telephone, monthly commuting cost, summer intern dates, reduced fare, and one regional and one organizational code.
Employee certification
A false statement warning under United States Code, Title 18, section 1001, and statements about GSA employment, worksite parking permits, fare media and the statutory limit, then the signature and date in items 18 and 19.
Supervisor and coordinator blocks
Signature, printed name and date for the first level supervisor (items 20 to 22) and the Transit Subsidy Coordinator (items 23 to 25).
Page 2: worksheet and split allocation
Rows for each mode to and from work with company, starting and ending points and daily, weekly or monthly cost, a vanpool row, a conversion table, and a SPLIT ALLOCATION line for Debit Card and SmarTrip Card.
Page 3: instructions and Privacy Act
Item-by-item instructions for page 1, notes on the worksheet and absences, and the Privacy Act statement.
How to complete GSA Form 3675A
- 1
Complete the SmartBenefits box
Check Current User or New User and enter the SmarTrip Card Serial Number. The form says the card must be registered in the employee's name.
- 2
Mark the application type
In item 1, check new applicant, change to application information, annual recertification, or cancellation (withdrawal or no longer eligible for the program).
- 3
Work out the monthly cost
On page 2, list costs by how you pay. The form says parking fees are not allowed, reduced fares count at the amount actually paid, and the total is rounded to the nearest dollar, with $.50 or more rounded up.
- 4
Complete page 1
Enter the worksheet total in item 11, your correspondence symbol, official worksite (not a telework location) and office telephone, and check one regional and one organizational code.
- 5
Sign and submit
Sign and date items 18 and 19. The instructions say to submit the completed application to your immediate supervisor, who signs the verification block.
These steps follow the instructions on page 3.
Why fill Form GSA3675A on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the GSA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes and what the form says
Where it goes
The instructions say to submit the completed application to your immediate supervisor. The form then has a block for the Transit Subsidy Coordinator. The PDF prints no mailing address.
Absences from work
If your actual commuting cost falls below your transit benefit, the form says a lesser amount is taken at the next distribution. Its example: $105.00 per month less $50.00 for ten days not using mass transit gives a request of $55.00.
False statements
The certification warns that a false statement is a Federal crime under United States Code, Title 18, section 1001, and may lead to criminal prosecution including a fine of up to $5,000 and/or administrative punishment.
Privacy
Authorities: Public Law 101-509; Executive Order 13150; and the Federal Employees Clean Air Incentives Act (section 2(a) of Public Law 103-172, found at 5 USC 7905). Furnishing the information is voluntary, but without it the request cannot be approved, and the form says it may be verified through a computer match.
Related forms
Who fills out GSA Form 3675A?
The form names the employee, the supervisor and the coordinator, each with a signature block.
Official sources and the blank
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Questions about Form GSA3675A
Who issues GSA Form 3675A?
The footer reads GENERAL SERVICES ADMINISTRATION and GSA 3675A (REV. 3/2016). GSA hosts the form in its forms library.
How is GSA Form 3675A different from GSA Form 3675?
GSA Form 3675A adds a SMARTBENEFITS box with Current User, New User and a SmarTrip Card Serial Number, and a split allocation line for a debit card and a SmarTrip card. The application items, certification and worksheet follow the same layout.
Whose name must the SmarTrip card be in?
The form says the SmarTrip card must be registered in the employee's name.
Who signs GSA Form 3675A?
The employee signs the certification, the first level supervisor signs to verify eligibility and commuting cost, and the Transit Subsidy Coordinator signs to verify the application is complete and signed.
Can parking fees be included in the commuting cost?
No. The worksheet says parking fees are not allowed and cannot be included when computing monthly transit costs.
How does the form count days per month?
It starts from an average 21-day work month and subtracts days you do not commute by mass transit, such as for an alternate work schedule, telework or regular travel. It says to subtract 2 days for a 5/4/9 schedule and 4 days for a 4/10 schedule.
Does the form ask for my full Social Security Number?
Item 7 asks for the last 4 digits. The Privacy Act statement says furnishing the information is voluntary, but without it the request for a transit subsidy benefit cannot be approved.