Fillable Printable 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