Va Form 0862 - Claim For Credit Of Annual Leave

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OMB Number: 2900-0669
Respondent Burden: 15 minutes
CLAIM FOR CREDIT OF ANNUAL LEAVE
NOTE: Please review page 2 for Privacy Act Statement and Respondent Burden before completing this form.
INSTRUCTIONS: The Federal Circuit in Butterbaugh v. Dept. of Justice, 336 F.3d 1332 (Fed. Cir. 2003), held that military leave should not have been charged prior to
December 21, 2000 (the date of the change in the military leave law) for administrative non-duty days that fell within a period of military leave. The Office of Personnel
Management (OPM) issued guidance for processing Butterbaugh-type administrative claims for annual leave which provided that, under the Barring Act, a leave claim
must be brought within six years after the claim accrued. However, the Merit System Protection Board (MSPB) has ruled that a Butterbaugh-related claim is a claim
under the Veterans Reemployment Rights Act (VRRA). Although the leave provisions of Chapter 63 of Title 5, United States Code (U.S.C.), specifically pertain to Title
5 employees, VA is extending the provisions of Butterbaugh to employees covered by regulations prescribed by VA pursuant to Title 38, U.S.C. 7421(a). Accordingly,
for Title 5 and Title 38 employees who are charged leave on an hourly basis, VA may accept administrative claims filed after July 24, 2003, for crediting additional leave
for military leave charged on administrative nonduty days between October 1, 1980, and December 21, 2000. Administrative claims filed after July 24, 2003, by Title 38
employees on 24/7 schedules for crediting annual leave for military leave charged on administrative nonduty days may be accepted back to October 1, 1980.
It is your responsibility to establish the validity of your claim by providing supporting documentation such as a copy of your military orders, certification of attendance,
or other documents indicating that you engaged in periods of active military duty for which you were charged military leave on nonworkdays. Failure to submit
supporting documentation may result in the denial of your claim.
Submit your signed and dated claim, VA Form 0862, and supporting documentation to your local payroll office. If you are a retired annuitant or separated from the
service of the VA, submit your claim to your last servicing payroll office.
NAME OF APPLICANT
SOCIAL SECURITY NO.
DAYTIME PHONE NUMBER (Include area code)
HOME MAILING ADDRESS (street, city, state, ZIP code)
CHECK APPLICABLE BOX
DATE
CURRENT EMPLOYEE
RETIRED ANNUITANT
SEPARATED/RESIGNATION FROM FEDERAL SERVICE
INSTRUCTIONS: Indicate below the period of time for which you are submitting a claim for leave
TITLE 5 EMPLOYEES
DATES (Attach documentation)
DATES (Attach documentation)
DATES (Attach documentation)
FROM
TO
FROM
TO
FROM
TO
1980
1981
1982
DATES (Attach documentation)
DATES (Attach documentation)
DATES (Attach documentation)
FROM
TO
FROM
TO
FROM
TO
1983
1984
1985
DATES (Attach documentation)
DATES (Attach documentation)
DATES (Attach documentation)
FROM
TO
FROM
TO
FROM
TO
1986
1987
1988
DATES (Attach documentation)
DATES (Attach documentation)
DATES (Attach documentation)
FROM
TO
FROM
TO
FROM
TO
1989
1990
1991
DATES (Attach documentation)
DATES (Attach documentation)
DATES (Attach documentation)
FROM
TO
FROM
TO
FROM
TO
1992
1993
1994
DATES (Attach documentation)
DATES (Attach documentation)
DATES (Attach documentation)
FROM
TO
FROM
TO
FROM
TO
1995
1996
1997
DATES (Attach documentation)
DATES (Attach documentation)
DATES (Attach documentation)
FROM
TO
FROM
TO
FROM
TO
1998
1999
2000
RESERVED
VA FORM
0862
JAN 2008

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