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Formerly Standard Form (SF) 1150A
Transfer of Leave Records for Leave Recipient
Covered by the Voluntary Leave Transfer Program
Agencies must use this form for the purpose of recording the status of a current leave recepient under the voluntary leave transfer
program (authorized under 5 U.S.C.6332) when he or she transfers to another Federal agency without a break in service. The employing
agency from which the employee is transferring must complete this form and forward it to the employing agency to which the employee
is transferring.
To Be Completed By Transferring Agency
1. Name of current leave recipient (Last, first, middle) 2. S61/DVWGLJLWV
3. Date medical emergency 4. Date medical emergency 5. Date employee was approved 6. Effective date of separation
began terminated
(if applicable) to become a leave recipient (transfer)
7. Total hours of annual leave donated to 8. Total hours of donated annual leave used 9. Total hours of unused donated annual
leave recipient as of the date of separation by the leave recipient as of the date of leave as of the date of separation
separation
10. Remarks - Provide a list of all employees who donated annual leave to the leave recipient, including the total amount of annual leave
donated by each employee
11a. Individual's name who can provide further information 11b. Telephone number
12a. Authorizing official's typed name 12b. Title
12c. Signature
12d. Date Signed
Office of Personnel Management
5 CFR 630
Local Reproduction Authorized OPM 630-C
click to sign
signature
click to edit
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