<table style="width:100%;">
<colgroup>
<col style="width: 20%" />
<col style="width: 10%" />
<col style="width: 2%" />
<col style="width: 7%" />
<col style="width: 10%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 8%" />
<col style="width: 2%" />
<col style="width: 18%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="18"><p><strong>Recommendation for Performance
Recognition</strong></p>
<p><em><strong>APRS Form 1291</strong></em></p></td>
</tr>
<tr class="even">
<td colspan="18"><strong>Associate Data</strong></td>
</tr>
<tr class="odd">
<td colspan="6"><p><strong>Name</strong> (If group award, attach
list)</p>
<p><strong>     </strong></p></td>
<td></td>
<td colspan="11"><p><strong>Social Security Number</strong></p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="6"><p><strong>Pay Plan, Series, Grade</strong></p>
<p><strong>     </strong></p></td>
<td></td>
<td colspan="11"><p><strong>Base Salary</strong></p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="4"><p><strong>Organization</strong> (Correspondence
Symbol)</p>
<p><strong>     </strong></p></td>
<td colspan="2"></td>
<td></td>
<td colspan="11"></td>
</tr>
<tr class="even">
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="18"><strong>Award Details</strong></td>
</tr>
<tr class="even">
<td colspan="11"><strong>Type of Award</strong></td>
<td colspan="7"><strong>Period of Recognition</strong></td>
</tr>
<tr class="odd">
<td colspan="8"><blockquote>
<p>Special Act</p>
</blockquote></td>
<td colspan="3"></td>
<td colspan="5"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="8"><blockquote>
<p>Individual Performance Award/QSI</p>
</blockquote></td>
<td colspan="3"></td>
<td colspan="7">Month / Year to Month / Year</td>
</tr>
<tr class="odd">
<td colspan="8"><blockquote>
<p>Organizational Performance Award</p>
</blockquote></td>
<td colspan="3"></td>
<td colspan="7"><strong>Proposed Effective Date</strong></td>
</tr>
<tr class="even">
<td colspan="8"><blockquote>
<p>Honor Awards:</p>
</blockquote></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="5">     </td>
</tr>
<tr class="odd">
<td colspan="8"><blockquote>
<p>Administrator’s Distinguished Service Award</p>
</blockquote></td>
<td colspan="3"></td>
<td colspan="7">Month / Day / Year</td>
</tr>
<tr class="even">
<td colspan="8"><blockquote>
<p>Administrator’s Meritorious Award</p>
</blockquote></td>
<td colspan="3"></td>
<td colspan="7"><strong>Quality Step Increase</strong></td>
</tr>
<tr class="odd">
<td colspan="8"><blockquote>
<p>Administrator’s Exceptional Service Award</p>
</blockquote></td>
<td colspan="3"></td>
<td colspan="6">     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="8"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="5">From Step to Step</td>
</tr>
<tr class="odd">
<td colspan="18"><strong>Amount of Award</strong></td>
</tr>
<tr class="even">
<td colspan="2"><blockquote>
<p>Gross Amount</p>
</blockquote></td>
<td colspan="3">$     </td>
<td colspan="13"><blockquote>
<p>Excluding Individual Performance Awards, awards over $5,000 gross
require Administrator’s Approval</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="18"></td>
</tr>
<tr class="even">
<td colspan="2"><blockquote>
<p>Time Off</p>
</blockquote></td>
<td colspan="3">      Hours</td>
<td colspan="13"><blockquote>
<p>Number of Hours to be granted not-to-exceed 80</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="18"></td>
</tr>
<tr class="even">
<td colspan="18"><strong>Award Recommendation and Approval</strong></td>
</tr>
<tr class="odd">
<td colspan="3"><strong>Recommending Official</strong></td>
<td colspan="11"></td>
<td></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="11">Signature</td>
<td></td>
<td colspan="3">Date</td>
</tr>
<tr class="odd">
<td colspan="7">Concur with Recommending Official</td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="7">Do not concur with Recommending Official</td>
<td colspan="4"></td>
<td colspan="7"></td>
</tr>
<tr class="odd">
<td>Adjust Award to</td>
<td colspan="5"><strong>     </strong></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="6"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="3"><strong>Approving Official</strong></td>
<td colspan="11"></td>
<td></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="11">Signature</td>
<td></td>
<td colspan="3">Date</td>
</tr>
<tr class="odd">
<td colspan="3"><strong>Budget Official</strong></td>
<td colspan="11"></td>
<td></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="11">Signature</td>
<td></td>
<td colspan="3">Date</td>
</tr>
<tr class="odd">
<td colspan="3"><strong>Administrator</strong></td>
<td colspan="11"></td>
<td></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="11">Signature</td>
<td></td>
<td colspan="3">Date</td>
</tr>
<tr class="odd">
<td colspan="9"><strong>General Services Administration</strong></td>
<td colspan="9"><strong>APRS Form 1291 (Rev 06-2005)</strong></td>
</tr>
</tbody>
</table>