Fillable Printable OPM Form 630C

OPM Form 630C

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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/DVWGLJLWV

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

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