Request for SES Noncareer or Limited Appointment Authority Part A - Agency Information 1. Agency name 2. Date of request (mm,dd,yyyy) 3. Date received at OPM (OPM use only) 4. Agency point of contact Telephone number E-mail FAX number 6. Request(s) for: 5. New noncareer appointment U.S. Office of Personnel Management Office of Executive Resources Management 1900 E Street NW, Room 6484 Washington, DC 20415-0001 Reassign a noncareer appointee Limited term appointment Requested duration: Months______ Days______ Limited emergency appointment (not to exceed 18 months) Extension of limited appointment Requested duration: Months______ Days______ Change in title (show current title below; show new title in 10a.) Attention____________________________ FAX number is (202) 606-2126 Other (specify on supplemental sheet, e.g. SES allocation) 7. Name of candidate 10a. Position title 8. EIS case number 10c. Office 10b. Organization 9. Position number 11. Recruited from Endorsement Statement I endorse the above request made to the Office of Personnel Management. I certify that the position is a General position and certify that the candidate meets the professional/technical, executive and managerial qualifications for this position. 13. Department/Agency head signature (or designee) 12. Department/Agency head name 14. Date signed Part B - Agency White House Liaison 1. Agency White House Liaison name 2. Agency White House Liaison signature 3. Date 4. Telephone Part C - OPM Use Only 1. Your request for a new noncareer appointment authority, reassignment or change is: Approved Modification Approved with modification Your request for a limited term or limited emergency appointment authority for the duration of_____________________ is: Disapproved Returned without action Your request for __ temporary space allocation is: 2a. Number of noncareer allocations, if approved 2b. 3. OPM White House Liaison signature 5. Signature of OPM approving official % Percent of SES space allocation 4. Date 6. Title of OPM approving official 7. Date signed Chief of Staff, OPM U. S. Office of Personnel Management Previous edition not usable OPM 1652 Revised February 2002 American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Completing OPM Form 1652 Request for SES Noncareer or Limited Appointment Authority This form has been prepared for you in a fillable Adobe Acrobat PDF format. Please fill in the requested information as follows: Part A - Agency SES Contacts/HR Office Boxes 1, 2, and 4 - Self-explanatory. Box 3 - Please leave blank - for OPM use only. Box 5 - Fill in the appropriate name of your Agency Officer in OPM's Office of Executive Resources Management. Box 6 - Use your cursor and click on the appropriate Box for the type of request you are making. Provide additional information, e.g. justification, project description, et al, on a separate sheet of a paper. If there is a change in position title, type in the current title in this space, and the new title in item 10a. Box 7 - Self-explanatory. Box 8 - Enter the case number assigned automatically when you successfully entered the data for this appointment in the Executive Information System (EIS). Please note: this request will not be processed without an EIS case number. Box 9 - Enter the position number of the position in Box 10a. Box 10a - Enter the position title. This title must match what is in EIS. Box 10b - Enter the organization or component, i.e., Forest Service. Box 10c - Enter the office name, i.e., Chief Financial Officer (CFO). Box 11 - If the candidate is not a current Federal employee, please enter the current title and employer. If a Federal employee, identify the agency, appointment type and level. Box 12 - Enter the Department/Agency head or appointing authority for SES positions who has certified that the proposed appointee meets executive, professional/technical, and managerial qualifications of the position to be filled. Box 13 - Signature of the Agency, Department head or a Designee. If this is different from Box 12, please enter the name, title and office. Box 14 - Self-explanatory. Part B - Agency White House Liaison – to be used only when requesting noncareer SES authority or when the candidate must be endorsed by the White House. Boxes 1 and 2 - Self-explanatory. The White House Liaison provides the White House Office of Presidential Personnel a copy of this request, along with other appropriate documentation on the candidate for the position. Boxes 3 and 4 - Once the White House Liaison has received confirmation that the White House has endorsed the candidate for the position being filled, the White House Liaison signs and dates Box 3 & 4, and provides the form to the agency HR SES contact. The SES contact faxes the form to OPM, Office of Executive Resources Management (OERM), 202 606-2126. Please note: Once Part B is completed, the form is printed and forwarded to the Agency White House Liaison. It helps to have your printer set to "Shrink to fit", "Fit to page" or “Print as Image” with Adobe Acrobat files, otherwise the text may print to the edge of the page, you may not get all of the image to print correctly, or all of the words will run together. Part C - Office of Executive Resources Management (OPM) OERM will be responsible for Part C, and will notify the agency SES contact/HR Office of the status of the request, once a determination has been made, and appropriate signatures are obtained. Agencies are not authorized to hire any individual to any of these appointments without the written approval and authorization of the Chief of Staff, OPM. Please contact your Agency Officer if you experience any problems with the form, or if these instructions need further clarification. (SES Staffing Center 202 606-2246) American LegalNet, Inc. www.FormsWorkFlow.com OPM 1652 (Reverse) Revised February 2002