Final salary payment report




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FINAL SALARY PAYMENT REPORT

Administrative Offset Procedures permit holding final paycheck and/or leave until accountable documents are returned.



Employee Name

     


SEPARATION DATE (LAST DAY OF PAY STATUS)

     


aGENCY

     


ORGANIZATIONAL UNIT

     


ITEMS REQUIRING CLEARANCE PRIOR TO FINAL SALARY PAYMENT

1. tRANSPORTATION REQUESTS

     


8. PROPERTY

     


2. IDENTIFICATION CARDS

 a. USDA IDENTIFICATION (AD-53)

 b. OFM/NFS USER ID

 c. OTHER (SPECIFY)



     

3. GOVERNMENT BILLS OF LADING

     


9. FUNDS

 a. TRAVEL ADVANCE

 b. FIELD PARTY ADVANCE

 c. IMPREST FUND ADVANCE

 d. COLLECTION OFFICER RECEIPTS

 e. OTHER (SPECIFY)



     

4. PARKING PERMIT

     


5. DRIVERS LICENSE (GOVERNMENT)

     


10. GAO EXCEPTION

     


6. CREDIT CARDS

 a. GASOLINE

 b. TELEPHONE

 c. VISA-TRAVEL

 d. VISA-PURCHASING

 e. OTHER (SPECIFY)



     

11. FISCAL LIABILITY

     


12. SERVICE AGREEMENTS FULFILLED

 a. TRANSFER OF OFFICIAL STATION

 b. FIRST POST OF DUTY

 c. TRAINING



7. OTHER ACCOUNTABLE DOCUMENTS (SPECIFY)

     


2. OTHER INDEBTEDNESS

 a. ADVANCED S/L

 b. ADVANCED A/L

 c. ADVANCED COMP



     

REMARKS:      

LEAVE BALANCES

A/L      

S/L      

COMP TIME      



     

Employee: Do you wish to have an exit interview?  YES;  NO




Signature:

Date:      

CERTIFICATION: I certify that the identified items have been checked against official records, except as noted, the above-named employee has properly accounted for each item. Action has been taken to revoke existing delegations of authority and any assignment under the Department’s position schedule bond.

ITEMS BEING CERTIFIED

(List by No. Below)

SIGNATURE AND TITLE OF OFFICIAL MAKING CERTIFICATION

DATE

     




     

     

Personnel

     

     

Administrative




     

Finance

     

AD-139 (USDA) (REV.5/2001)


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