FINAL SALARY PAYMENT REPORT - USDA
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 |11. FISCAL LIABILITY |
|a. GASOLINE | |
|b. TELEPHONE | |
|c. VISA-TRAVEL | |
|d. VISA-PURCHASING | |
|e. OTHER (SPECIFY) | |
| | |
| |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 |SIGNATURE AND TITLE OF OFFICIAL MAKING CERTIFICATION |DATE |
|(List by No. Below) | | |
| | | |
| |Personnel | |
| |Administrative | |
| |Finance | |
AD-139 (USDA) (REV.5/2001)
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