GSA · Official form

SF 1150 Record of Leave Data

Standard Form 1150 certifies a federal employee's leave balances at separation or transfer. Payroll offices use it to pay out unused annual leave or transfer leave credit to a new agency.

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This is the genuine GSA PDF, unmodified. Source: GSA official page.

What is SF 1150?

SF 1150, Record of Leave Data, is prepared by an agency's payroll or HR office when an employee separates from federal service or transfers to another agency. It records the employee's annual leave, sick leave, and other leave balances as of the effective date, along with the data needed to compute a lump-sum payment for unused annual leave or to credit the balances at the gaining agency.

The form is an internal payroll document rather than something the employee fills out, but employees often request a copy because it is the official record of their leave at the time they left. A rehired employee's sick leave balance, for example, is typically recredited based on the SF 1150 from the prior separation.

Who files SF 1150?

Agency payroll and HR offices documenting leave balances when an employee separates or transfers
Gaining agencies that need certified balances to credit transferred leave
Employees who want the official record of their leave balances for a future return to federal service
Payroll offices computing lump-sum annual leave payments at separation

How to fill out SF 1150

The losing agency's payroll office completes the form as of the employee's separation or transfer date.
Leave balances are entered by category: annual leave, sick leave, and any other applicable leave types.
The certifying officer signs the form, making it the official leave record for the separation.
For transfers, the form is sent to the gaining agency's payroll office so balances can be credited; for separations, it supports the lump-sum leave payment.
Employees should request a copy for their records; it is the document a future agency will want if you return to federal service.

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These are the form's own fields, in the order they appear on the pages. Fill in what you know; anything left blank stays a fillable field in the PDF, so you can finish it in any PDF reader. Nothing you type here is sent to GSA.

Page 1 127 fields

DATE OF SEPARATION Enter 2 digit month, 2 digit day and 4 digit year.

2. SOCIAL SECURITY NUMBER

3. (FOR AGENCY USE)

5. A SUBJECT TO 5 U.S.C. 6304(B) (45 DAY LEAVE CEILING). YES.

5. A. SUBJECT TO 5 U.S.C. 6304(B) (45 DAY LEAVE CEILING). NO.

B. LAST DATE SUBJECT TO 5 U.S.C. 6304(B). Enter 2 digit month, 2 digit day and 4 digit year.

C. ANNUAL LEAVE BALANCE AS OF THAT DATE (HOURS).

MORE THAN 15 YEARS

LESS THAN 15 YEARS

SHOW YEARS

MONTHS

DAYS

7. CARRYOVER BALANCE FROM PRIOR LEAVE YEAR ENDING. MONTH.

7. CARRYOVER BALANCE FROM PRIOR LEAVE YEAR ENDING. DAY.

7. CARRYOVER BALANCE FROM PRIOR LEAVE YEAR ENDING. YEAR.

CARRYOVER BALANCE ANNUAL HOURS

CARRYOVER BALANCE SICK HOURS

CARRYOVER BALANCE RESTORED HOURS

8. CURRENT LEAVE YEAR ACCRUAL THROUGH PAY PERIOD ENDING. MONTH.

8. CURRENT LEAVE YEAR ACCRUAL THROUGH PAY PERIOD ENDING. DAYS.

8. CURRENT LEAVE YEAR ACCRUAL THROUGH PAY PERIOD ENDING. YEAR.

CURRENT LEAVE ANNUAL HOURS

CURRENT LEAVE SICK HOURS

CURRENT LEAVE HOURS RESTORED

10. REDUCTION IN CREDITS, IF ANY (CURRENT). ANNUAL.

10. REDUCTION IN CREDITS, IF ANY (CURRENT YEAR). SICK.

10. REDUCTION IN CREDITS, IF ANY (CURRENT YEAR). RESTORED.

11. TOTAL LEAVE TAKEN, CURRENT YEAR THROUGH DATE OF SEPARATION. ANNUAL.

11. TOTAL LEAVE TAKEN, CURRENT YEAR THROUGH DATE OF SEPARATION. SICK.

11. TOTAL LEAVE TAKEN, CURRENT YEAR THROUGH DATE OF SEPARATION. RESTORED.

13. TOTAL LEAVE TAKEN, CURRENT YEAR THROUGH DATE OF SEPARATION. ANNUAL.

13. TOTAL LEAVE TAKEN, CURRENT YEAR THROUGH DATE OF SEPARATION. RESTORED.

15. LUMP SUM LEAVE DATES (IF PART-TIME TOUR, EXPLAIN IN REMARKS). FROM MONTH.

15C. ANNUAL LEAVE WITHIN CEILING. THROUGH MONTH.

15C. ANNUAL LEAVE WITHIN CEILING. FROM MONTH.

15B. ANNUAL LEAVE ABOVE CEILING. THROUGH MONTH.

15B. ANNUAL LEAVE ABOVE CEILING. FROM MONTH.

15.A. RESTORED THROUGH MONTH.

15. A. RESTORED FROM MONTH.

15. LUMP SUM LEAVE DATES (IF PART-TIME TOUR, EXPLAIN IN REMARKS). THROUGH MONTH.

15. LUMP SUM LEAVE DATES (IF PART-TIME TOUR, EXPLAIN IN REMARKS). FROM DAY.

15C. ANNUAL LEAVE WITHIN CEILING. THROUGH DAY.

15C. ANNUAL LEAVE WITHIN CEILING. FROM DAY.

15B. ANNUAL LEAVE ABOVE CEILING. THROUGH DAY.

15B. ANNUAL LEAVE ABOVE CEILING. FROM DAY.

15. A. RESTORED THROUGH DAY.

15. A. RESTORED FROM DAY.

15. LUMP SUM LEAVE DATES (IF PART-TIME TOUR, EXPLAIN IN REMARKS). THROUGH DAY.

15. LUMP SUM LEAVE DATES (IF PART-TIME TOUR, EXPLAIN IN REMARKS). FROM YEAR.

15C. ANNUAL LEAVE WITHIN CEILING. THROUGH YEAR.

15C. ANNUAL LEAVE WITHIN CEILING. FROM YEAR.

15B. ANNUAL LEAVE ABOVE CEILING. THROUGH YEAR.

15B. ANNUAL LEAVE ABOVE CEILING. FROM YEAR.

15. A. RESTORED THROUGH YEAR.

15. A. RESTORED FROM YEAR.

15. LUMP SUM LEAVE DATES (IF PART-TIME TOUR, EXPLAIN IN REMARKS). THROUGH YEAR.

15. LUMP SUM LEAVE DATES (IF PART-TIME TOUR, EXPLAIN IN REMARKS). FROM HOURS.

15C. ANNUAL LEAVE WITHIN CEILING. THROUGH YEARS.

15C. ANNUAL LEAVE WITHIN CEILING. FROM HOURS.

15B. ANNUAL LEAVE ABOVE CEILING. THROUGH HOURS.

15B. ANNUAL LEAVE ABOVE CEILING. FROM HOURS.

15. A. RESTORED THROUGH HOURS.

15. A. RESTORED FROM HOURS.

15. LUMP SUM LEAVE DATES (IF PART-TIME TOUR, EXPLAIN IN REMARKS). THROUGH HOURS.

16. DURING LEAVE YEAR IN WHICH SEPARATED. HOURS.

17. A. DATE OF LAST EQUIVALENT INCREASE. MONTH.

17. A. DATE OF LAST EQUIVALENT INCREASE. DAY.

17. A. DATE OF LAST EQUIVALENT INCREASE. YEAR.

17 B. TOTAL LWOP HOURS SINCE LAST EQUIVALENT INCREASE (EXCEPT DURING MILITARY SERVICE AND WHILE IN RECEIPT OF OWCP PAYMENTS). HOURS.

18. BASIC SERVICE PERIOD OF 24 MONTH OF CONTINUOUS SERVICE ABROAD. DATE STARTED. MONTH.

18. BASIC SERVICE PERIOD OF 24 MONTH OF CONTINUOUS SERVICE ABROAD. DATE STARTED. YEAR.

18. BASIC SERVICE PERIOD OF 24 MONTH OF CONTINUOUS SERVICE ABROAD. DATE STARTED. DAY.

18. BASIC SERVICE PERIOD OF 24 MONTHS OF CONTINUOUS SERVICE ABROAD. DATE COMPLETED. YEAR.

18. BASIC SERVICE PERIOD OF 24 MONTHS OF CONTINUOUS SERVICE ABROAD. DATE COMPLETED. DAY.

18. BASIC SERVICE PERIOD OF 24 MONTH OF CONTINUOUS SERVICE ABROAD. DATE COMPLETED. MONTH.

19. CURRENT 12 MONTHS ACCRUAL PERIOD BEGAN ON MONTH.

19. CURRENT 12 MONTH ACCRUAL PERIOD BEGAN ON YEAR.

19. CURRENT 12 MONTH ACCRUAL PERIOD BEGAN ON DAY.

HOURS ABSENT WITHOUT PAY SINCE THAT DATE.

20. CURRENT BALANCE (OR ACCRUAL ) AS OF MONTH.

20. CURRENT BALANCE (OR ACCRUAL) AS OF YEAR.

20. CURRENT BALANCE (OR ACCRUAL) AS OF DAY.

NUMBER OF DAYS.

21. TWELVE MONTH ACCRUAL DATE AS OF DATE OF SEPARATION. NUMBER OF DAYS.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM MONTH.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO YEAR.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO DAY.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO MONTH.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM YEAR.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM DAY.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM MONTH.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO YEAR.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO DAY.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO MONTH.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM YEAR.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM DAY.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM MONTH.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO YEAR.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO DAY.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO MONTH.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM YEAR.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM DAY.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM MONTH.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO YEAR.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO DAY.

22. DATES LEAVE USED PRIOR 24 MONTHS. TO MONTH.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM YEAR.

22. DATES LEAVE USED PRIOR 24 MONTHS. FROM DAY.

23. DURING CURRENT CALENDAR YEAR. A. REGULAR ACTIVE DUTY OR TRAINING. FROM MONTH.

23. DURING CURRENT CALENDAR YEAR. A. REGULAR ACTIVE DUTY OR TRAINING. TO YEAR.

23. DURING CURRENT CALENDAR YEAR. A. REGULAR ACTIVE DUTY OR TRAINING. TO DAY.

23. DURING CURRENT CALENDAR YEAR. A. REGULAR ACTIVE DUTY OR TRAINING. TO MONTH.

23. DURING CURRENT CALENDAR YEAR. A. REGULAR ACTIVE DUTY OR TRAINING. FROM YEAR

23. DURING CURRENT CALENDAR YEAR. A. REGULAR ACTIVE DUTY OR TRAINING. FROM DAY.

23. DURING CURRENT CALENDAR YEAR. B. SPECIAL-CIVIL DISTURBANCE. FROM MONTH.

23. DURING CURRENT CALENDAR YEAR. B. SPECIAL-CIVIL DISTURBANCE. TO YEAR.

23. DURING CURRENT CALENDAR YEAR. B. SPECIAL-CIVIL DISTURBANCE. TO DAY.

23. DURING CURRENT CALENDAR YEAR. B. SPECIAL-CIVIL DISTURBANCE. TO MONTH.

23. DURING CURRENT CALENDAR YEAR. B. SPECIAL-CIVIL DISTURBANCE. FROM YEAR.

23. DURING CURRENT CALENDAR YEAR. B. SPECIAL-CIVIL DISTURBANCE. FROM DAY.

24. REMARKS (INCLUDE SHORE LEAVE INFORMATION, IF APPLICABLE;)

TitleAgency

2 digit month, 2 digit day and 4 digit year.

1. NAME (LAST, FIRST, MIDDLE)

14. SALARY RATE(S) PER HOUR

4. DATE AND NATURE OF SEPARATION.

13. Enter the total hours paid for holidays as part of the total hours paid in a Lump Sum.

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Frequently asked questions

Do I fill out the SF 1150 myself?

No. Your agency's payroll office prepares and certifies it. Your part is to review it for accuracy and keep a copy, since it documents balances you may want credited later.

What happens to my sick leave when I leave federal service?

Unused sick leave is not paid out, but it is recorded on the SF 1150. If you later return to federal service, the balance can generally be recredited, and for retirees under FERS or CSRS unused sick leave counts toward the annuity computation.

SF 1150 Record of Leave Data

What is SF 1150?

Who files SF 1150?

How to fill out SF 1150

Quick fill SF 1150 on this page

Frequently asked questions

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