GSA5047
Actual Place of Residence Determination
GSA Form 5047, Actual Place of Residence Determination, is a four-page General Services Administration (GSA) form, printed as GSA 5047 6/2024 with OMB Control Number 3090-0333 and an expiration date of 6/30/2027. GSA hosts it in its forms library.
The form says an employee's "actual place of residence in the U.S.," as determined by an appointing agency, determines eligibility for permanent change of station (PCS) relocation costs under 5 U.S.C. §§ 5722 and 5724(d) and for home leave travel, also known as renewal agreement travel, under 5 U.S.C. § 5728. It notes the same determination can be used for the 45-day annual leave accrual authority, home leave and living quarters allowance.
Section A is a cover sheet with the determined residence and the Human Resources Specialist's signature. Section B is a worksheet based on Comptroller General decisions, used when the cover sheet says a worksheet is required. GSA estimates it will take 1 hour to read the instructions, gather the facts and answer the questions. You can fill it out free in your browser on this page and download the result without an account.
The candidate's name, background on the statutes the determination serves, and the rule under GSA Order 5730.1 that the actual place of residence is usually the principal, actual dwelling place in fact at the time of selection.
A city and state for candidates residing in the U.S. at appointment or transfer, and for DoD candidates in a foreign area, the residence from Line Item G of DoD Form 1617.
The country, city and state found to be the employee's actual place of residence, with the Human Resources Specialist's name, signature and date.
Current physical residence at appointment or transfer, whether it is temporary and only incident to Government duties, the residence in agency records such as the W-2 mailing address, and residence during the prior 5 years.
Family connections to a location, voter registration and voting jurisdiction, U.S., state, local and foreign income tax, and long-standing ties through birth, youth, education or marriage.
Page 3 holds the Privacy Act statement, and page 4 lists five instructions for Human Resources Offices.
Collect the DoD Form 1617, if applicable, and demographic information.
The cover sheet marks the U.S. resident and DoD Form 1617 cases as Worksheet Not Required. The form says other cases use the Section B worksheet.
Section B asks about each category of evidence. The form says to consider the preponderance of the evidence if there are multiple possible places of residence.
Based on the totality of the evidence, document via the worksheet and complete the cover sheet. The form says the place is determined upon the facts and circumstances of each individual case.
Sign and date the Section B worksheet, if applicable, and the Section A cover sheet.
Submit the form to the GSA OCFO Travel and Relocation Office for use in its determination and inclusion within GSA Forms 87A and 2255.
The instructions on page 4 list these steps for Human Resources Offices.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The instructions say to submit it to the GSA Office of the Chief Financial Officer (OCFO), Travel and Relocation Office. The GSA address in the Paperwork Reduction Act statement is for comments relating to the time estimate.
GSA estimates it will take 1 hour to read the instructions, gather the facts, and answer the questions.
The form notes that an appointee whose current location is a foreign country may not be eligible for foreign allowances and benefits, and that a resume and the original relocation package can support a lost transportation agreement.
The form says the information is used only by the GSA Office of Human Resources Management and the employee's new supervisor, and is stored in OPM's Electronic Personnel Folder (eOPF) under SORN OPM/GOVT-1.
The form says failure to provide the information may lead to the erroneous payment of compensation and benefits, or the non-payment of eligible compensation and benefits.
GSA5048
47 fields, 4 pages
GSA5049
32 fields, 4 pages
GSA87A
293 fields, 2 pages
GSA2255
32 fields, 1 page
The instructions on page 4 are addressed to Human Resources Offices. These are the people and offices the form names.
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The footer reads GENERAL SERVICES ADMINISTRATION and GSA 5047 6/2024, and the header shows OMB Control Number 3090-0333 with an expiration date of 6/30/2027. GSA hosts it in its forms library.
The instructions are for Human Resources Offices. A Human Resources Specialist interviews the candidate, completes the form and signs it. The candidate supplies information such as the DoD Form 1617, if applicable.
The cover sheet says it is not required for candidates residing in the U.S. at appointment or transfer, or for DoD candidates with a DoD Form 1617. It is used for DoD candidates abroad without that form and for candidates from other federal agencies.
Physical residence at selection, residence in agency records, residence according to employment history, individual or family association with an area, voting and paying taxes, and place of birth, education and marriage.
To the GSA Office of the Chief Financial Officer (OCFO), Travel and Relocation Office, for use in their determination and inclusion within GSA Forms 87A and 2255.
GSA estimates it will take 1 hour to read the instructions, gather the facts, and answer the questions.
