Data Transmittal Sheet - National Urban Search And Rescue Response System
ADVERTISEMENT
1NATIONAL URBAN SEARCH AND RESCUE RESPONSE SYSTEM
DATA TRANSMITTAL SHEET
HQ: _Washington DC_
REGION: IX DUTY STATION: _____________________
APPROPRIATION CODE: ___________
IS THIS EMPLYEE A CITIZEN OF THE UNITED STATES? ____________
IF NO, OF WHAT COUNTRY IS HE/SHE A CITIZEN? ___________________________
NAME: ________________________________
MALE: ______
FEMALE: _____
BIRTHDATE: ____________________
SSN: _______________ PAY PLAN: _____________
RETIREMENT STATUS: ___ NONE ___CS ___RETO ___CS&RETO ___CS&RE
ENTRANCE ON DUTY DATE: ___/___/___
POSITION TITLE: National Urban Search and Rescue Response System Member
(Excepted Temporary Federal Volunteer)
NATURE OF ACTION: SF171
OF612
APPT. NOT TO EXCEED: ___/___/___
HANDICAP CODE: _____(SF-258)
MINORITY DESIGNATION: ________(SF-181)
DATE OATH OF OFFICE ADMINISTERED: ___/___/___
EDUCATION: HIGH SCHOOL DIPLOMA ___YES ___NO
COLLEGE DEGREE ___YES ___NO
MAJOR FIELD OF STUDY: ________________________
DEGREE TYPE: ___BA ___BS ___MA ___MS ___PhD
Year: _______
EMPLOYEE’S PERMANENT MIALING ADDRESS:
APPROVED BY:
____________________________________
Bruce P. Baughman
____________________________________
Division Director, Operations Division
____________________________________
Response and Recovery Directorate
RETIREMENT INFORMATION: CS RETIREES: MONTHLY ANNUITY $_________________
MILITARY: BRANCH OF SERVICE: ______________________________
RANK: _____________________________
DATE OF RETIREMENT: ___/___/___
TAX INFORMATION:
STATE: ____
MARRIED: ____
SINGLE: ____
# OF EXEMPTIONS: _______
FEDERAL: (FORM W-4) MARRIED: ____ SINGLE: ____ # OF EXEMPTIONS: _______
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business