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Fillable Printable Severance Pay Worksheet

Fillable Printable Severance Pay Worksheet

Severance Pay Worksheet

Severance Pay Worksheet

GENERAL SERVICES ADMINISTRATION GSA FORM 3637 (REV. 12-93 )
Prescribed by OAD P 9550.1
SEVERANCE PAY WORKSHEET
NAME OF EMPLOYEE (Last, First)
SOCIAL SECURITY NUMBER
I. SERVICE
a. SEPARATION DATE (YY/MM/DD)
b. SCD LEAVE (YY/MM/DD)
c. SERVICE (Item a - Item b)
(YY/MM/DD)
d. DD 214 (YY/MM/DD)
e. SERVICE (Item c - Item d)
(YY/MM/DD)
i. NUMBER OF WEEKS
(Item g + (2 * Item h))
h. SERVICE OVER 10 YEARS
g. SERVICE TO 10 YEARS
f. TOTAL SERVICE (years)
II. AGE
a. SEPARATION DATE (YY/MM/DD) d. AGE (years)
b. DATE OF BIRTH (YY/MM/DD)
c. AGE (Item a - Item b) (YY/MM/DD) f. AGE FACTOR (Item e/10) (years)
e. AGE OVER 40 (Item d - 40) (years)
III. WEEKLY RATE
PER ANNUM RATE
a. ADJUSTED RATE d. STANDBY RATE (Item c * Item b)
b. HOURLY RATE (Item a/2087)
c. STANDBY (%) f. WEEKLY RATE (Item e * 40)
e. HOURLY RATE (Item b + Item d)
PER HOUR RATE
g. HOURLY RATE i. FULL HOURLY RATE (Item g + Item h)
h. NIGHT DIFFERENTIAL j. WEEKLY RATE (Item i * 40)
IV. SEVERANCE PAY FUND
a. BASIC ALLOWANCE (Item Ii * Item
IIIf) or (Item Ii * Item IIIj)
b. AGE ADJUSTMENT
(Item a * Item IIf)
c. RAW FUND (Item a + item b)
d. 52 WEEKS PAY (Item IIIf * 52) or
(Item IIIj * 52)
h. FINAL FUND (Item e - Item g)
g. VALUE (Item f * Item IIIf) =
(Item f * Item IIIj)
f. PRIOR WEEKS SEVERANCE PAY (If
you received previous severance pay,
your benefits will be reduced.)
e. FUND (The lesser of Item c and d)
V. SEVERANCE PAYMENTS
a. WEEKLY RATE (Item IIIf or Item IIIj)
d. WEEKS (Item IVh/Item a) d. FINAL PAYMENT
c. BIWEEKLY PAYMENT (Item a * 2)
CERTIFICATION
SIGNATURE OF
PERSONNEL SPECIALIST
DATE
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