STEP 1

(Fill in 1-19 and hit NEXT below to Request Space at Fort Sam Houston San Antonio, TX)
Any questions, please contact:fsh.bto@conus.army.mil
REQUEST FOR SPACE
(The proponent is IMSW-SMH-PAI)
Section 1 - REQUESTOR
1a. ORGANIZATION NAME:
1b. SELECT ONE:
ARMY DOD  FEDERAL (NON-DOD) OTHER
2. HIGHER HQS:
3. MISSION:
4a. UIC:

4b. 2-DIGIT CUSTOMER NB (FSH ONLY):
5a. NO. OF FULL-TIME PERSONNEL:

5b. NO. OF PART-TIME PERSONNEL:
6. AFFILIATION WITH OTHER ORGANIZATIONS LOCATED ON POST:
7. DATE OF REQUEST (DDMMMYYYY) : 8. DATE SPACE IS REQUIRED (DDMMMYYYY) :
9. JUSTIFICATION FOR SPACE:
9a. If space is required by a contract, enter contract #:

9b. Space Requirement is:  Permanent Temporary        9c. How long?

9d. Reason:
10a. NAME OF PRIMARY POC AND TITLE:
 10b. BUSINESS ADDRESS:
10c. PHONE NUMBER:
 10d. FAX NUMBER:
 10e. E-MAIL ADDRESS:
11a. NAME OF SECONDARY POC AND TITLE:
 11b. BUSINESS ADDRESS:
11c. PHONE NUMBER:
 11d. FAX NUMBER:
 11e. E-MAIL ADDRESS:
12a. NAME OF FINAL DECISION MAKER AND TITLE:
 12b. BUSINESS ADDRESS:
12c. PHONE NUMBER:
 12d. FAX NUMBER:
 12e. E-MAIL ADDRESS:
13a. RESOURCES AVAILABLE FOR MOVE:
YES NO 		13b. TYPE OF RESOURCE (OMA, DHP, etc):
14. FURNITURE AT CURRENT LOCATION :
YES NO 		15. Moving it to new location :
YES NO
16. CURRENT SPACE OCCUPIED :
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17. SPECIAL REQUIREMENTS, E.G., CLASSROOM, STORAGE, CONFERENCE ROOM, WAREHOUSE, PATIENT WAIT AREA, HANDICAP, VTC ROOM, HEAVY EQUIPMENT, MOTOR POOL, ETC.
18. SPECIAL INFORMATION TECHNOLOGY (IT) REQUIREMENTS (E.G. SIPRNET, SECURE VTC, ETC.):
19. COMMENTS (Provide additional details and use a separate sheet if necessary.):
Section II - PLANS, ANALYSIS, AND INTEGRATION OFFICE (PAIO)
1. REVIEWED BY:
2. SIGNATURE OF REVIEWER:
3. RECOMMENDED ZONE:
AMEDD TRAINING CAMPUS     BASOPS SUPPORT:                         BAMC CAMPUS

COMMUNITY CENTER               LIGHT INDUSTRIAL & STORAGE        OTHER
4. COMMENTS:
Section III - ENGINEERING AND MAINTENANCE OPERATIONS (REAL ESTATE)
1. SPACE ASSIGNED (Bldg/room/area):
2. KEYS PROVIDED TO:
3. PHONE NUMBER:
4. DATE ASSIGNED:
5. ASSIGNED BY:
6. RECOMMENDATIONS/COMMENTS:
CSFS FORM 4342-E-R, JUL 2005 PAGE 2 OF 2 CSFS V1.00

01/12/2012