Request for Schedule C Appointment Authority Part A - Agency Information 1. Agency name 2. Date of request 4. Agency point of contact Telephone number 5. 3. Date received at OPM (mm,dd,yyyy) (mm,dd,yyyy) (OPM use only) E-mail FAX number 6. Reason(s) for submission: New authority Reestablishment of authority U.S. Office of Personnel Management Washington Service Center 1900 E Street NW, Room 2469 Washington, DC 20415-9930 Upgrade or downgrade from ________ to __________ Change in title Change in immediate supervisor Change in organizational location or name Attention_________________________ FAX number: (202)606-3603 Notice of entry on duty Notice of position vacated Notice of TTC appointment Effective date of action, EOD, vacate or amendment __________ 8. Pay plan, series, grade or salary 7. Position title 9. Position number (OPM assigned) 10. Duty station (city and state code) 11. Name of candidate 12. Position description certification (Official's type of appointment) ✔ PAS PA SES - General 13a. Supervisor's title 13b. Appointment type PAS PA Schedule C - provide grade SES - General Certification Statement I certify the position above, that we request the Office of Personnel Management to except from the competitive service because of its confidential or policy-determining character, was not created solely or primarily in order to detail the employee to the White House. 14. Department/Agency head name 15. Department/Agency head signature (or designee) 16. Date signed Part B - Agency White House Liaison 1. Agency White House Liaison name 2. Telephone number 3. Agency White House Liaison signature 4. Date signed Part C - OPM Use Only 1. Your request for a Schedule C exception, reestablishment or amendment is: Disapproved Approved 2. If this action is approved, the Department/Agency's number of Schedule C positions will Returned without action Increase 3. OPM White House Liaison signature Remain the same 4. Date signed 5. Signature of OPM approving official U. S. Office of Personnel Management Prior editions not usable. Clear Form Decrease 6. Title of OPM approving official 7. Date signed OPM 1019 Revised April 2001 Print Form Save Form American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING OPM FORM 1019 A. Requesting a New Position or Reestablishment of a Position Submit the following to OPM: 1. One OPM Form 1019 with parts A (including the Certification Statement) and B completed. 2. A copy of the official position description (PD), with a cover sheet (OF-8 or similar) signed and certified within the past six months by a Presidential appointee (PAS or PA) or a Senior Executive Service (SES) appointee in a General position (cannot be in a Career Reserved position). Note: The PD must clearly show a confidential relationship with the immediate supervisor or state a required policy determining aspect of the position. 3. An organization chart with the subject position highlighted or circled. B. Requesting an Amendment to an Occupied Position Provide 1 through 3 as shown in A above. Note: An amendment to an occupied Schedule C position involves one or more of the following: change in title, series, grade, duties, name of organization, duty location, or reporting relationship. C. Reporting Entry-on-Duty (EOD) and Vacate Dates Within 3 working days of entry-on-duty (EOD), vacating or the effective date of an amendment of a Schedule C position, the agency must FAX a copy of the previously approved OPM Form 1019 with the effective date of action noted in Part A, item 6. Note: When a Schedule C incumbent leaves a position the authority for the position is automatically revoked. D. Instructions for Completing Part A Items not listed below are self-explanatory. Item 6: Check the appropriate box or boxes – provide grade levels or date, if applicable. Item 7: Enter the position title – if a title change, enter the new title. Item 8: Enter the grade and series if the position is in the General Schedule, otherwise, show the GS equivalent or base salary. Item 9: Enter the number previously assigned by OPM. Leave blank, if not assigned. Item 10: Enter the duty station (city and state code). Item 11: Enter the name of the candidate (with a middle initial, if known). Item 12: Check the box showing the appointment type of the official who signs the position description. This official must occupy a PAS or PA position, or be a SES appointee in a General position. Item 13a: Enter the supervisor’s title. Item 13b: Check the appropriate box for the supervisor’s appointment type. E. Certification Statement Section 617 of Public Law 106-58 requires agencies to submit a certification to the Office of Personnel Management regarding detailing Schedule C employees to the White House. To comply, the Department/Agency head, acting head, or a designated official must sign the Certification Statement on the OPM Form 1019. Please call 202-606-1892 or 202-606-1391 if you have questions concerning this form. OPM 1019 (Back) Revised April 2001 American LegalNet, Inc. www.FormsWorkFlow.com