Form Cd-529 - Lump Sum Leave Or Compensatory Time Payments Template
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1
2U.S. DEPARTMENT OF COMMERCE
CD-529
FORM
(1-94) LF
LUMP SUM LEAVE OR COMPENSATORY TIME PAYMENTS
1.
SOCIAL SECURITY NUMBER
2.
NAME (Last, FIrst, Middle Initial)
3.
AGENCY CODE
4.
DATE OF SEPARATION
5.
TYPE OF PAYMENT
6.
TAX
7.
MINUS S/L
8.
PAY COLA
9.
PAY AUO
(If Applicable)
0= INTERIM
0= N/A
0= N/A
0= NO
0= NO
1= FINAL
1= 20% TAX
1= FORGIVEN
1= YES
1= YES
MO
DAY
YR
10. WAGE EMPLOYEE SHIFT RATE HOURS
11. DATES LUMP SUM PAYMENT CARRIES THROUGH
12. HOURS APPLI-
13. TOTAL HOURS
CABLE TO LAST
TO BE PAID
1ST
2ND
3RD
VAR
A.
A/L RESTORED
B.
A/L WITHIN CEILING
C. A/L ABOVE CEILING
DAY OF LSP
MO
DAY
YR
MO
DAY
YR
MO
DAY
YR
MANUAL PAY DATA (FOR NFC USE ONLY)
14. PAY CODE
15. SCHEDULE NUMBER
16. GROSS PAY
17. FEDERAL TAX
18. FICA
19. HOSPITAL INSURANCE
1= UPDATE ONLY
2= UPDATE ONLY
EXCEPT QTD
20. STATE TAX
21. CITY TAX
22. COUNTY TAX
22A. RECEIPT ACCOUNT
23. AMOUNT NET PAY
ST. CD
AMOUNT
ST. CD
CITY CD
AMOUNT
ST. CD
COUN. CD
AMOUNT
NUMBER
AMOUNT
24. ACCOUNTING DATA USAGE CODE
26. TOTAL LINES OF ACCOUNTING DATA
27. REMARKS
0= COMPLETE BLOCK 25
1= USE DATA BASE
25. ACCOUNTING DATA
HOURS
FRAC
(1)
(2)
(3)
(4)
(5)
(6)
(7)
28. EMPLOYING OFFICE CODE
29. REHIRE DATE AFTER SEPARATION
(8)
MONTH
DAY
YEAR
(9)
30. T&A CONTACT POINT
AGENCY
STATE
TOWN
UNIT
TIMEKEEPER
(10)
31. TOUR OF DUTY (Hours Per Day)
1ST WEEK
2ND WEEK
SUN
MON
TUES
WED
THURS
FRI
SAT
SUN
MON
TUES
WED
THURS
FRI
SAT
32B. LEAVE YEAR
EARNED
32. AUDIT FOR LEAVE
BROUGHT FORWARD
USED
BALANCE OR TOTAL
RESTORED ANNUAL
32A.
32C. LEAVE CATEGORY
T
Y
ANNUAL
P
E
32D. SERVICE COMP DATE
SICK
O
F
32E. EOD (If in Year of Audit)
AWOP
L
E
RATE
A
V
E
RATE
COMP
RATE
33. APPROVAL
FOR NFC USE ONLY
SIGNATURE OF AUTHORIZED OFFICIAL
TITLE
DATE
INITIALS
DATE
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