CTMD Form 5-2 "Request for Orders" - Connecticut

What Is CTMD Form 5-2?

This is a legal form that was released by the Connecticut Military Department - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2015;
  • The latest edition provided by the Connecticut Military Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of CTMD Form 5-2 by clicking the link below or browse more documents and templates provided by the Connecticut Military Department.

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Download CTMD Form 5-2 "Request for Orders" - Connecticut

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CTMD Form 5-2
(Rev. 5/2015)
CONNECTICUT MILITARY DEPARTMENT
INSTRUCTIONS FOR
REQUEST FOR ORDERS
PURPOSE: To request orders for personnel to be placed on State Active Duty for a predetermined period of time
TIMEFRAME: All requests for State Active Duty must be made no later than thirty days prior to the start date of duty to
be performed.
REQUESTOR INFORMATION: Name & contact information of individual requesting the member be placed on State
Active Duty
INDIVIDUAL INFORMATION: Name, address, contact information and demographic information for the individual being
placed on State Active Duty in order to ensure they receive the correct pay & allowances. Pay is based upon their rank,
pay date & dependent status
Rank/Grade: Current military rank and pay grade or highest rank assigned upon discharge/retirement.
Pay Date: Official date upon which your military pay is determined for years of service. Normally, the date you
first joined the military or Armed Forces of the State.
Dependent Status: Answer YES if married or have dependent children under 22 years of age. Answer NO for all
others.
Employee ID#: Your State of Connecticut employee identification number. If unknown or first time on State
Active Duty, please leave blank.
DUTY INFORMATION:
Detailed information on when, where and what duty will be performed. Also include the contact
information on the individual’s immediate supervisor who will be responsible for certifying that duty has been completed.
ACCOUNTING INFORMATION: Funding information will be determined by the CTMD Military Administrative & Programs
Officer. Base Pay & Allowances will be calculated based upon grade, pay date and dependent status in accordance with
current military pay tables. The Fringe Benefit Reimbursement Rate (FBRR) will be added to the Total Pay in order to
determine the Total Cost to be applied against the appropriate accounting codes. The accounting codes will be provided
by the CTMD Fiscal Administrative Manager. All requests for State Active Duty must have a funding source or they will be
applied against the CTMD General Operations account while funding exists.
ADJUTANT GENERAL APPROVAL: The Adjutant General, or his designee, reserves the right to disapprove any
request for State Active Duty, regardless of funding availability. Appeals must be made directly to the Office of the
Adjutant General.
SEND REQUEST FOR ORDERS TO:
Connecticut Military Department
Military Administrative & Programs Officer
360 Broad Street Room #113
Hartford, Connecticut, 06105-3706
(860) 524-4968
(860) 493-2721 (fax)
russell.bonaccorso@ct.gov (e-mail)
Page 1 of 2
CTMD Form 5-2
(Rev. 5/2015)
CONNECTICUT MILITARY DEPARTMENT
INSTRUCTIONS FOR
REQUEST FOR ORDERS
PURPOSE: To request orders for personnel to be placed on State Active Duty for a predetermined period of time
TIMEFRAME: All requests for State Active Duty must be made no later than thirty days prior to the start date of duty to
be performed.
REQUESTOR INFORMATION: Name & contact information of individual requesting the member be placed on State
Active Duty
INDIVIDUAL INFORMATION: Name, address, contact information and demographic information for the individual being
placed on State Active Duty in order to ensure they receive the correct pay & allowances. Pay is based upon their rank,
pay date & dependent status
Rank/Grade: Current military rank and pay grade or highest rank assigned upon discharge/retirement.
Pay Date: Official date upon which your military pay is determined for years of service. Normally, the date you
first joined the military or Armed Forces of the State.
Dependent Status: Answer YES if married or have dependent children under 22 years of age. Answer NO for all
others.
Employee ID#: Your State of Connecticut employee identification number. If unknown or first time on State
Active Duty, please leave blank.
DUTY INFORMATION:
Detailed information on when, where and what duty will be performed. Also include the contact
information on the individual’s immediate supervisor who will be responsible for certifying that duty has been completed.
ACCOUNTING INFORMATION: Funding information will be determined by the CTMD Military Administrative & Programs
Officer. Base Pay & Allowances will be calculated based upon grade, pay date and dependent status in accordance with
current military pay tables. The Fringe Benefit Reimbursement Rate (FBRR) will be added to the Total Pay in order to
determine the Total Cost to be applied against the appropriate accounting codes. The accounting codes will be provided
by the CTMD Fiscal Administrative Manager. All requests for State Active Duty must have a funding source or they will be
applied against the CTMD General Operations account while funding exists.
ADJUTANT GENERAL APPROVAL: The Adjutant General, or his designee, reserves the right to disapprove any
request for State Active Duty, regardless of funding availability. Appeals must be made directly to the Office of the
Adjutant General.
SEND REQUEST FOR ORDERS TO:
Connecticut Military Department
Military Administrative & Programs Officer
360 Broad Street Room #113
Hartford, Connecticut, 06105-3706
(860) 524-4968
(860) 493-2721 (fax)
russell.bonaccorso@ct.gov (e-mail)
Page 1 of 2
CTMD Form 5-2
(Rev 5/2015)
CONNECTICUT MILITARY DEPARTMENT
REQUEST FOR ORDERS
REQUESTOR INFORMATION
Name:
Directorate
Phone Number:
E-Mail
INDIVIDUAL INFORMATION
Last Name
First Name
Middle Initial
Mailing Address
City
State
Zip Code
Phone Number
E-Mail
Rank/Grade
Pay Date:
Dependent Status:
Employee ID#
Social Security Number
DUTY INFORMATION
Dates Requested:
Total Duty Days:
Report Time:
Duty Location: (Address, Building, Room, etc.):
Duty Description:
Supervisor Name:
Phone Number:
E-Mail:
Signature of Requestor
Date
TO BE COMPLETED BY CTMD MILITARY ADMINISTRATIVE & PROGRAMS OFFICER
Orders #
Base Pay:
Allowances:
FBRR:
Total Pay:
Total Cost:
Department:
Fund Code:
SID:
Program Code:
Budget Year:
TAG Approved
TAG Disapproved
CTMD MAPO Signature
Date
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