Fillable Printable OPM Form 1639

OPM Form 1639

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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