U.S. FISH WILDLIFE SERVICE PCS Lump Sum Pilot . FISH & WILDLIFE SERVICE PCS Lump Sum Pilot ... Relocation… page 1

U.S. FISH WILDLIFE SERVICE PCS Lump Sum Pilot . FISH & WILDLIFE SERVICE PCS Lump Sum Pilot ... Relocation…

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  • U.S.FISH&WILDLIFESERVICEPCSLumpSumPilotAdvanceofFundsApplication

    FWS3248508/16

    TheServiceusesthisformtoprocesstheinitialportionofaPermanentChangeofStation(PCS)lumpsumpaymentasanadvance.TheRelocationCounselorandemployeecompletethisformwithForm3139Aiftheemployeeselectsthelumpsumpaymentmethod.

    SECTIONA:IDENTIFYINGINFORMATION

    Name(First,MiddleInitial,Last):

    EmployeeIdentificationNumber(EIN):

    DateReportingtoNewDutyStation:

    SECTIONB:ADVANCEOFFUNDSINFORMATION

    ThepaymentamountisdeterminedduringtherelocationcounselingprocessanddocumentedonForm3139A.Thepurposeofthisformistoprocess74%oftheportionofthelumpsumpaymentthatisavailableupfrontasanadvance.

    Ifemployeequalifiesforcompensationforsaleofprimaryresidence:

    TotalLumpSumPaymentAmount:

    PortionAvailableUpFront(74%oftotalpayment):

    AmountHeldtoCoverTaxes(26%ofupfrontportion):

    AmounttobePaidasAdvance(74%ofupfrontportion):

    Ifemployeedoesnotqualifyforcompensationforsaleofprimaryresidence:

    TotalLumpSumPaymentAmount:

    AmountHeldtoCoverTaxes(26%oftotalpayment):

    AmounttobePaidasAdvance(74%oftotalpayment):

    SECTIONC:REQUIREDSIGNATURES(ElectronicsignaturesacceptableunlessRegionalpolicyrequireshardcopysignaturesonPCSforms)

    IamparticipatinginthePCSlumpsumpilotprogramandagreetoreceivetheportionofmylumpsumpaymentidentifiedinSectionBasanadvance.IagreetoappearatmynewdutystationonthedatespecifiedbytheServiceandunderstandthefundingprovidedperSectionBissubjecttothetermsandconditionsinmyEmployeeRelocationAgreement.IntheeventthatIfailtoremainintheFederalGovernmentserviceforaperiodof12monthsfollowingtheeffectivedateofmytransfer,unlessseparatedforreasonsbeyondmycontrolandacceptabletotheService,thelumpsumpayment(s)issuedtomeshallberecoverablefrommeasadebtduetotheUnitedStates(28U.S.C.2514).

    ________________________________________________________ApplicantSignatureDate

    MysignatureconfirmsthattheemployeerequirestheadvanceinSectionBtocompletehis/herrelocation.

    _________________________________________________________RelocationCounselorSignatureDate

    IapprovetheemployeetoreceivetheadvanceoffundsasindicatedinSectionBofthisform.

    _________________________________________________________ApprovingOfficialSignature(FWS)Date

    _________________________________________________________AuthorizedCertifyingOfficialSignature(IBC)Date

    Employee_Name: Employee_EIN: RE_Total: NoRE_Total: RE_UpFront: 0NoRE_Held: 0RE_Held: 0NoRE_Advance: 0RE_Advance: 0Employee_Date: RC_Date: AO_Date: ACO_Date: Report_Date: