Code 10 Pay Rate

NOTIFICATION OF PERSONNEL ACTION

Standard Form **

Rev. 7/91

U.S. Office of Personnel Management

FPM Supp. 296−33, Subch. 4

1. Name (Last, First, Middle) 2. Social Security Number 3. Date of Birth 4. Effective Date FIRST ACTION

5−A. Code 5−B. Nature of Action

5−C. Code 5−D. Legal Authority

5−E. Code 5−F. Legal Authority

SECOND ACTION

6−A. Code 6−B. Nature of Action

6−C. Code 6−D. Legal Authority

6−E. Code 6−F. Legal Authority

7. FROM: Position Title and Number

8. Pay Plan 9. Occ. Code 10. Grade or Level 11. Step or Rate 12. Total Salary 12A. Basic Pay 12B. Locality Adj. 12C. Adj. Basic Pay 12D. Other Pay 13. Pay Basis

14. Name and Location of Position’s Organization

15. TO: Position Title and Number

16. Pay Plan 17. Occ. Code 18. Grade or Level 19.Step or Rate 20. Total Salary/Award 20A. Basic Pay 20B. Locality Adj. 20C. Adj. Basic Pay 20D. Other Pay 21. Pay Basis

22. Name and Location of Position’s Organization

EMPLOYEE DATA

23. Veterans Preference

1 − None 3 − 10−Point/Disability 5 − 10−Point/Other 2 − 5−Point 4 − 10−Point/Compensable 6 − 10−Point/Compensable/30% 24. Tenure

0 − None 2 − Conditional

1 − Permanent 3 − Indefinite

25. Agency Use 26. Veterans Preference for RIF

YES NO

27. FEGLI 28. Annuitant Indicator 29. Pay Rate Determinant 30. Retirement Plan 31. Service Comp. Date (Leave) 32. Work Schedule 33. Part−Time Hours Per Biweekly

Pay Period

POSITION DATA

34. Position Occupied

1 − Competitive Service 3 − SES General

2 − Excepted Service 4 − SES Career Reserved

35. FLSA Category

E − Exempt

N − Nonexempt

36. Appropriation Code 37. Bargaining Unit Status

38. Duty Station Code 39. Duty Station (City − County − State or Overseas Location) 40. Agency Data 41. 42. 43. 44.

45. Remarks

46. Employing Department or Agency

47. Agency Code 48. Personnel Office ID 49. Approval Date 50. Signature/Authentication and Title of Approving Official 5−Part 50−316 2 - OPF Copy - Long-Term Record - DO NOT DESTROY NSN 7540−01−333−6238 Editions Prior to 7/91 Are Not Usable After 6/30/93

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