Authorization to Transfer Leave From a Donor

• Legal Form Number: BP-A0834
• Date: 2010-06
• Year: 2010
• Section: Federal Bureau of Prisons

BP-A0834 U.S. DEPARTMENT OF JUSTICE

JUN 10 FEDERAL BUREAU OF PRISONS

AUTHORIZATION TO TRANSFER LEAVE FROM A DONOR

1. Name 2. Title 3. SSN

4. Pay Plan/Series/Grade/Step 5. Annual Salary 6. Office Phone

7. SCD 8. Organization 9. Duty Location

10. Org. Code 11. Appropriate Code 12. Timekeeper

13. Timekeeper’s Phone 14. Timekeeper’s Duty Location

15. Designated Agent 16. Designated Agent’s Phone

17. As of (ending date of latest pay period), I have the following

annual leave balance: hours. (Attach copy of T&A for the latest pay

period.)

18. *My annual leave ceiling is hours.

19. *As of the pay period specified in item #17, I have hours of

projected annual leave above my ceiling which could be subject to forfeiture at the end

of the leave year. I have scheduled (formally requested and approved by my supervisor)

the use of annual leave, sick leave or compensatory time off for the following periods

of time during the remainder of this leave year:

Periods of Scheduled Leave Total Hours

Annual Leave

Sick Leave

Compensatory Time Off

*Not applicable to SES employees

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