Transfer of Leave Records for Leave Recipient Covered by the Voluntary Leave Transfer Program Agencies must use this form for the purpose of recording the status of a current leave recepient under the voluntary leave transfer program (authorized under 5 U.S.C.6332) when he or she transfers to another Federal agency without a break in service. The employing agency from which the employee is transferring must complete this form and forward it to the employing agency to which the employee is transferring. To Be Completed By Transferring Agency 1. Name of current leave recipient (Last, first, middle) 2. SSN (Last 4 digits) 3. Date medical emergency began 4. Date medical emergency terminated (if applicable) 5. Date employee was approved 6. Effective date of separation to become a leave recipient (transfer) 7. Total hours of annual leave donated to 8. Total hours of donated annual leave used 9. Total hours of unused donated annual leave recipient as of the date of separation by the leave recipient as of the date of leave as of the date of separation separation 10. Remarks - Provide a list of all employees who donated annual leave to the leave recipient, including the total amount of annual leave donated by each employee 11a. Individual's name who can provide further information 11b. Telephone number 12a. Authorizing official's typed name 12b. Title 12c. Signature 12d. Date Signed Office of Personnel Management 5 CFR 630 Local Reproduction Authorized American LegalNet, Inc. www.FormsWorkFlow.com OPM 630-C August 2013 Formerly Standard Form (SF) 1150A