<table>
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</colgroup>
<tbody>
<tr class="odd">
<td colspan="29"><strong>HUMAN RESOURCES SOURCE DOCUMENT</strong></td>
</tr>
<tr class="even">
<td colspan="23">Name</td>
<td colspan="6"><strong>CM57</strong></td>
</tr>
<tr class="odd">
<td colspan="29"></td>
</tr>
<tr class="even">
<td colspan="8"><strong>1 TSP Data</strong></td>
<td colspan="8" rowspan="2"><strong>2. SCD-RIF</strong></td>
<td colspan="9" rowspan="2"><strong>3. SCD-WGI</strong></td>
<td colspan="4" rowspan="2"><strong>4. Type of Appointment</strong></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>a. Eligibility Code</strong></td>
<td colspan="6"><strong>B SCD</strong></td>
</tr>
<tr class="even">
<td colspan="8"><strong>5. Benefit Coverage</strong></td>
<td colspan="6" rowspan="2"><strong>6. NTE Date</strong></td>
<td colspan="5" rowspan="2"><strong>7. Losing/Gaining
Dept.</strong></td>
<td colspan="6" rowspan="2"><strong>8. Losing/Gaining
Agency</strong></td>
<td colspan="4" rowspan="2"><p><strong>9. Starting Date of</strong></p>
<blockquote>
<p><strong>Service Year</strong></p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>a. FEHBA</strong></td>
<td colspan="6"><strong>b. FEGLI Amount</strong></td>
</tr>
<tr class="even">
<td colspan="14"><strong>10. APPOINTMENT LIMIT</strong></td>
<td colspan="15"><strong>11. PMSO DATA</strong></td>
</tr>
<tr class="odd">
<td><strong>FULL</strong></td>
<td colspan="5"><strong>a. Dollars</strong></td>
<td colspan="4"><strong>b. Hours</strong></td>
<td colspan="4"><strong>c. Days</strong></td>
<td colspan="5" rowspan="2"><strong>a. Master Record
Number</strong></td>
<td colspan="7" rowspan="2"><strong>b. Individual Position
Number</strong></td>
<td colspan="3" rowspan="2"><p><strong>c. Class Action Code</strong></p>
<blockquote>
<p><strong>□ No Action</strong></p>
<p><strong>1 □ Abolish</strong></p>
<p><strong>2 □ Inactivate</strong></p>
</blockquote></td>
</tr>
<tr class="even">
<td><strong>BALANCE</strong></td>
<td colspan="5"><strong>d. Dollars</strong></td>
<td colspan="4"><strong>e. Hours</strong></td>
<td colspan="4"><strong>f. Days</strong></td>
</tr>
<tr class="odd">
<td colspan="7" rowspan="2"><strong>12. Probationary or Trial Period
Start Date</strong></td>
<td colspan="7" rowspan="2"><strong>13. Grade Retention Expiration
Date</strong></td>
<td colspan="5" rowspan="2"><strong>14. Career (Or Permanent) Tenure
Date</strong></td>
<td colspan="10"><strong>15. SUPERVISORY/MANAGERIAL PROBATIONARY
PERIOD</strong></td>
</tr>
<tr class="even">
<td colspan="7"><strong>A. Starting Date</strong></td>
<td colspan="3"><p><strong>b. Required</strong></p>
<blockquote>
<p><strong>□ Not Required</strong></p>
<p><strong>1 □ Required</strong></p>
<p><strong>2 □ Served</strong></p>
<p><strong>3 □ Waived</strong></p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="4" rowspan="2"><strong>16. Last Date in Pay
Status</strong></td>
<td colspan="8" rowspan="2"><strong>17. Projected Sick Leave Usage
Date</strong></td>
<td colspan="12"><strong>18. ANNUAL LEAVE</strong></td>
<td colspan="5"><strong>19. SENSITIVE DATA</strong></td>
</tr>
<tr class="even">
<td colspan="3"><strong>a. Category</strong></td>
<td colspan="5"><strong>b. Earning Status During Pay
Period</strong></td>
<td colspan="4"><strong>c. 45-Day Code</strong></td>
<td colspan="4"><strong>a. RND</strong></td>
<td><strong>b. Handicap</strong></td>
</tr>
<tr class="odd">
<td colspan="11"><strong>20. SPECIAL EMPLOYMENT CODES</strong></td>
<td colspan="11"><strong>21. SALARY SHARE</strong></td>
<td colspan="7"><strong>22. HOURLY COOPERATIVE AGREEMENT
RATE</strong></td>
</tr>
<tr class="even">
<td colspan="3"><strong>a. Program</strong></td>
<td colspan="8"><strong>b. Employee</strong></td>
<td colspan="6"><strong>a. Amount</strong></td>
<td colspan="5"><strong>b. Code</strong></td>
<td colspan="5"><strong>a. Overtime</strong></td>
<td colspan="2"><strong>b. Holiday</strong></td>
</tr>
<tr class="odd">
<td colspan="9"><strong>23. QUARTERS DEDUCTION</strong></td>
<td colspan="12" rowspan="2"><strong>24. COLA/POST Differential
Code</strong></td>
<td colspan="8" rowspan="2"><p><strong>25. Uniform Service
Component</strong></p>
<blockquote>
<p><strong>0 □ None 3 □ National Guard</strong></p>
<p><strong>1 □ Ready Reserve 4 □ Retired Military Regular</strong></p>
<p><strong>2 □ Standby Reserve 5 □ Retired Military Non-Reg</strong></p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="5"><strong>a. Amount</strong></td>
<td colspan="4"><strong>b. Code</strong></td>
</tr>
<tr class="odd">
<td colspan="29"><strong>26. RETIREMENT SERVICE</strong></td>
</tr>
<tr class="even">
<td colspan="5"><strong>a. Frozen Service</strong></td>
<td colspan="8"><strong>b. Coverage at Appointment</strong></td>
<td colspan="5"><strong>c. Creditable Military</strong></td>
<td colspan="8"><strong>d. Date Retired Military Service</strong></td>
<td colspan="3"><strong>e. SCD-RET</strong></td>
</tr>
<tr class="odd">
<td colspan="29"><strong>DEPARTMENT USE</strong></td>
</tr>
<tr class="even">
<td colspan="5"><strong>27.</strong></td>
<td colspan="8"><strong>28.</strong></td>
<td colspan="5"><strong>29.</strong></td>
<td colspan="8"><strong>30.</strong></td>
<td colspan="3"><strong>31.</strong></td>
</tr>
<tr class="odd">
<td colspan="29"><strong>REMARKS</strong></td>
</tr>
</tbody>
</table>

(1989, Revised 1991)