Transfer Of Donated Annual Leave To-From The Emergency Leave Transfer Program {OPM 1639}

Transfer of Donated Annual Leave To or From the Emergency Leave Transfer Program Agency representatives must use this form for the purpose of donating or receiving annual leave from other agencies for the emergency leave transfer program. This form will be used only when an agency does not receive sufficient amounts of donated leave for their approved emergency leave recipients. OPM will facilitate the transfer of donated leave from/to agencies. Completed Form Must Be Faxed To OPM's Pay And Leave Administration Division - (202) 606-0824 1. Name of agency and/or organization 2. Major disaster or emergency declared by the President 3. Total number of hours (in whole hour increments) of donated annual leave available for transfer from your agency/organization to the emergency leave transfer program 4. Number of emergency leave recipients approved by your agency 5. Estimated number of hours (in whole hour increments) of donated annual leave needed for transfer to approved emergency leave recipients in your agency 6a. Name of individual who can provide further information 6b. Telephone number (including area code) 6c. FAX number (including area code) 6d. Email address 7a. Authorizing agency official's signature 7b. Date signed 7c. Authorizing agency official's typed name 7d. Authorizing agency official's title For OPM Use Only for Receiving or Transferring Donated Leave 8. Number of hours approved (in whole increments) of annual leave donated by your agency/organization to the emergency leave transfer program 9. Number of hours (in whole hour increments) of donated annual leave transferred from the emergency leave transfer program to your agency/organization for dissemination to approved leave recipients 10a. OPM official's signature Hours from agency Hours to agency 10b. Date signed 10c. Authorizing OPM official's typed name 10d. Authorizing OPM official's title Office of Personnel Management 5 CFR 630 Local Reproduction Authorized American LegalNet, Inc. www.FormsWorkFlow.com OPM 1639 Revised August 2013 Previous editions are usable