Standard Form 52
Rev. 8/88
U.S. Office of Personnel Management
FPM Supp. 296
| Part A--Requesting Office (Also complete Part B, Items 1, 7-22, 32, 33, 36 and 39.) | ||||||||||||
| 1. Action Requested |
2. Request Number |
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| 3. Additional Information Call (Name and Telephone Number) |
4. Proposed Effective Date |
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| 5. Action Requested By (Typed Name, Title, Signature, and Request Date) |
6. Action Authorized By (Typed Name, Title, Signature, and Concurrence Date) | |||||||||||
| Part B - For Preparation of SF 50 (Use only codes in FPM Supplement 292-1. Show all dates in month-day-year order.) | ||||||||||||
| 1. Name (Last,First, Middle)
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2. SSN
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3. DOB
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4. Effective Date
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| FIRST ACTION | SECOND ACTION | |||||||||||
| 5-A. Code
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5-B. Nature of Action
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6-A. Code
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6-B. Nature of Action
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| 5-C. Code
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5-D. Legal Authority
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6-C. Code
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6-D. Legal Authority
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| 5-E. Code
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5-F. Legal Authority
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6-E. Code
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6-F. Legal Authority
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| 7. From: Position Title and Number
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15. To: Position Title and Number
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| 8.Pay Plan
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9. Occ. Code
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10.Grade/Level
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11.Step/Rate
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12. Total Salary
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13.Pay Basis
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16.Pay Plan
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17. Occ. Code
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18.Grade/Level
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19.Step/Rate
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20.Total Salary/Award
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21.Pay Basis
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| 12A. Basic Pay
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12B. Locality Adj.
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12C. Adj. Basic Pay
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12D. Other Pay
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20A. Basic Pay
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20B. Locality Adj.
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20C. Adj. Basic Pay
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20D. Other Pay
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| 14. Name and Location of Position's Organization
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22. Name and Location of Position's Organization
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| EMPLOYEE DATA | ||||||||||||
| 23. Veterans Preference
1 - None 2 - 5 Point 3 - 10 Point/Disability 4 - 10 Point/Compensable 5 - 10 Point/Other 6 - 10 Point/Compensable/30% |
24. Tenure
0 - None 1 - Permanent 2 - Conditional 3 - Indefinite |
25. Agency Use This block not used by the Department of Commerce
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26. Veterans Preference for RIF | |||||||||
| 27. FEGLI
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28. Annuitant Indicator | 29. Pay Rate Determinant
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| 30. Retirement Plan
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31. Service Comp. Date(Leave)
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32. Work Schedule
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33. Part time hours Per Biweekly Pay Period |
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| POSITION DATA | ||||||||||||
| 34. Position Occupied
1 - Competitive Service 2 - Excepted Service 3 - SES General 4 - SES Career Reserved |
35. FLSA Category
E - Exempt N- Nonexempt |
36. Appropriation Code | 37. Bargaining Unit Status
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| 38. Duty Station Code
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39. Duty Station (City - County - State or Overseas Location)
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| 40. Agency Data
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41.
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42.
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43.
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44.
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| 45. Educational Level | 46. Year Degree Attained | 47. Academic Discipline | 48. Functional Class | 49. Citzenship 1 - USA 8 - Other |
50. Veterans Status | 51. Supervisory Status | ||||||
| Part C--Reviews and Approvals Not to be used by requesting office.) | ||||||||||||
| 1. Office/Function | Initials/Signature | Date | 1.Office/Function | Initials/Signature | Date | |||||||
| A. | D. | |||||||||||
| B. | E. | |||||||||||
| C. | F. | |||||||||||
| 2. Approval: I certify that the information entered on this form is accurate and that the proposed action is in compliance with statutory and regulatory requirements. | Signature | Approval Date | ||||||||||
| Part D--Remarks by Requesting Office | |||||||||||||||||||||||||||||||||||||||||
| (Note to Supervisors: Do you know of additional or conflicting reasons for the employee's
resignation/retirement? If "YES", please state these facts on a separate sheet and attach to SF 52.) | |||||||||||||||||||||||||||||||||||||||||
| Part E--Employee Resignation/Retirement | |||||||||||||||||||||||||||||||||||||||||
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You are requested to furnish a specific reason for your resignation
or retirement and a forwarding address. Your reason may be
considered in any future decision regarding your re-employment in
the Federal service and may also be used to determine your
eligibility for unemployement compensation benefits. Your
forwarding address will be used primarily to mail you copies of
any doccument you should have or any pay or compensation to which
you are entitled.
This information is requested under authority of sections 301, 3301, and 8506 of title 5, U.S. Code. Sections 301 and 3301 authorize |
OPM and agencies to issue regulations with regard to
employment of individuals in the Federal service and their
records, while section 8506 requires agencies to furnish the
specfic reason for termination of Federal service of the Secretary
of Labor or a State agency in connection with administration of
unemployment compensation programs.
The furnishing of this information is voluntary; however, failure to provide it may result in your not receiving: (1) your copies of those documents you should have; (2) pay or other compensation due you; and (3) any unemployment compensation benefits which you may be entitled. |
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1. Reasons for Resignation/Retirement (NOTE: Your reasons are used
in determining possible unemployment benefits. Please be
specific and avoid generalizations. Your resignation/retirement is effective at the end of the day - midnight - unless you specify otherwise.) |
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| 2. Effective Date | 3. Your Signature | 4. Date Signed |
5. Forwarding Address (Number, Street, City, State, ZIP Code)
| Part F--Remarks for SF 50 |
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