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Opm1639 (U.S. Office of Personnel Management)

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Transfer of Donated Annual Leave To or From the
Emergency Leave Transfer Program
Agency representatives must use this form for the purpose of donating or receiving annual leave from other agencies for the emergency
leave transfer program. This form will be used only when an agency does not receive sufficient amounts of donated leave for their
approved emergency leave recipients. OPM will facilitate the transfer of donated leave from/to agencies.
Completed Form Must Be Faxed To OPM's Pay And Leave Administration Division - (202) 606-0824
1. Name of agency and/or organization
2. Major disaster or emergency declared by the President
3. Total number of hours (in whole hour 4. Number of emergency leave recipients 5. Estimated number of hours (in whole hour
increments) of donated annual leave approved by your agency increments) of donated annual leave
available for transfer from your needed for transfer to approved emergency
agency/organization to the emergency leave recipients in your agency
leave transfer program
6a. Name of individual who can provide further information 6b. Telephone number (including area code)
number (including area code) 6c. FAX
6d. Email address
7a. Authorizing agency official's signature
7b. Date signed
7c. Authorizing agency official's typed name
7d.
Authorizing agency official's title
For OPM Use Only for Receiving or Transferring Donated Leave
Hours from agency
8. Number of hours approved (in whole increments) of annual leave donated by your agency/organization to the
emergency leave transfer program
Hours to agency
9. Number of hours (in whole hour increments) of donated annual leave transferred from the emergency leave
transfer program to your agency/organization for dissemination to approved leave recipients
10a.
OPM official's signature
10b. Date signed
10c.
Authorizing OPM official's typed name
10d. Authorizing OPM official's title
Office of Personnel Management
5 CFR 630
Local Reproduction Authorized
OPM 1639
Revised August 2013
Previous editions are usable
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Opm1639 (U.S. Office of Personnel Management)

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Completed 26 July 2020

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