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Opm 630c Fillable Form
Agency to which the employee
is transferring.
To Be Completed By Transferring Agency
1. Name of current leave recipient (Last, first, middle)
3. Date medical emergency
began
2. Social Security Number
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...
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