**CHECKLIST FOR COMPLETION OF FORM AD 287-2**

**"RECOMMENDATION AND APPROVAL OF AWARDS**"

If recommending a group award, attach a sheet listing the information
for blocks #1 through #6 and \# 14 (individual amount) for each employee
in the group.

  ----------- --------------- --------------------------------------------
  Block \# 1  Agency Name     Enter employee's agency (ie., FAS, FSA, RMA,
                              etc)

  Block \# 2  Name of         Enter employee's name (Name must be listed
              Employee        as it should appear on the certificate. Name
                              should be the name on the official personnel
                              file )

  Block \# 3  Soc Security    Enter employee's correct Social Security
              Number          Number (SSN) If SSN is not known, leave
                              blank.

  Block \# 4  Position Title  Enter employee's current position title.

  Block \# 5  Pay             Enter employee's pay plan, series, grade and
              Plan-Series/    step (ie., GS-0303/07/01, if known. If not
              Grade/Step      known, leave blank.

  Block \# 6  Organization    Enter employee's current Branch and Division
              and Location    followed by their physical location. (ie.,
                              ITP, Wash DC)

  Block \# 7  Period Covered  Enter the beginning and ending dates of the
              for Award       contribution for which the employee is being
                              recommended. Use the format : mmddyy to
                              mmddyy.

  Block \# 8  Accounting Code Enter the accounting code of the office of
                              the Recommending Individual. If not known,
                              contact the Secretary of that office.

  Block \# 9  Mail Check To:  Leave Blank. All money is electronically
                              deposited in employee's account.

  Block \# 10 List of Awards  List previous awards, if known. Leave blank
              . .             if unknown.

  Block \# 11 Citation        Enter citation exactly as you wish for it to
                              appear on the certificate. Please ensure the
                              citation does not exceed 25 words and is
                              appropriate for public recognition.
                              Citations are not required for Performance
                              awards. This is NOT the award justification.
                              Award justification must be on a separate
                              bond paper attached to the AD 287-2.

  Block \# 12 Type of         Check the appropriate box.
              Recognition     
  ----------- --------------- --------------------------------------------

+----------+--------------+--------------------------------------------+
| **C      |              |                                            |
| HECKLIST |              |                                            |
| FOR      |              |                                            |
| CO       |              |                                            |
| MPLETION |              |                                            |
| OF FORM  |              |                                            |
| AD       |              |                                            |
| 287-2**  |              |                                            |
|          |              |                                            |
| *        |              |                                            |
| *"RECOMM |              |                                            |
| ENDATION |              |                                            |
| AND      |              |                                            |
| APPROVAL |              |                                            |
| OF       |              |                                            |
| A        |              |                                            |
| WARDS**" |              |                                            |
|          |              |                                            |
| (        |              |                                            |
| C        |              |                                            |
| ontinued |              |                                            |
| )        |              |                                            |
+----------+--------------+--------------------------------------------+
| Block \# | No. of       | If recommending an individual, put "1". If |
| 13       | Persons      | recommending a group award, put the total  |
|          |              | number of employees in the group (i.e.,    |
|          |              | "12').                                     |
+----------+--------------+--------------------------------------------+
| Block \# | Total Award  | Enter the value of the award, either in    |
| 14       |              | dollars or in hours.                       |
|          |              |                                            |
|          |              | If recommending a group, put the total     |
|          |              | value of the award in Block 14. Put the    |
|          |              | amount of each employee's portion of the   |
|          |              | total award on the attached sheet along    |
|          |              | with Block \# 1 through \# 6 information.  |
+----------+--------------+--------------------------------------------+
| Block \# | Total Dollar | If you are aware of a dollar amount the    |
| 15       | Amt/Hrs      | Government has saved because of the        |
|          | Based On:    | contribution, check "Measurable Benefits   |
|          |              | Scale" and enter it in the "Estimated      |
|          |              | First Year Savings" block. If a dollar     |
|          |              | savings is not available, check            |
|          |              | "Non-measurable Benefits Scale," an        |
|          |              | complete the "Value of Benefits" and       |
|          |              | "Application" blocks.                      |
+----------+--------------+--------------------------------------------+
| ***If    |              |                                            |
| reco     |              |                                            |
| mmending |              |                                            |
| employee |              |                                            |
| for a    |              |                                            |
| Per      |              |                                            |
| formance |              |                                            |
| Bonus    |              |                                            |
| Award or |              |                                            |
| a QSI,   |              |                                            |
| complete |              |                                            |
| blocks   |              |                                            |
| 16       |              |                                            |
| through  |              |                                            |
| 19. If   |              |                                            |
| not,     |              |                                            |
| skip to  |              |                                            |
| Block    |              |                                            |
| 20.***   |              |                                            |
+----------+--------------+--------------------------------------------+
| Block \# | Type of      | Check the appropriate box.                 |
| 16       | Recognition  |                                            |
+----------+--------------+--------------------------------------------+
| Block \# | Date of Last | Complete only if recommending for a QSI    |
| 17       | Promotion    | and if known.                              |
+----------+--------------+--------------------------------------------+
| Block \# | Date of Last | Complete only if recommending a QSI and if |
| 18       | Within Grade | known.                                     |
|          | Increase     |                                            |
+----------+--------------+--------------------------------------------+
| Block \# | Amount       | Complete with dollar amount. If            |
| 19       | Recommended  | recommending QSI., leave blank.            |
|          | for Perf     |                                            |
|          | Award        |                                            |
+----------+--------------+--------------------------------------------+
| Block \# | Recommending | Sign, date, and type your title.           |
| 20       | Individual   |                                            |
+----------+--------------+--------------------------------------------+
| Block \# | Reviewing    | Sign, date, and type your title.           |
| 21       | Official     |                                            |
+----------+--------------+--------------------------------------------+
| Block \# | Approving    | Sign, date, and type your title            |
| 22       |              |                                            |
|          | Official     |                                            |
+----------+--------------+--------------------------------------------+
| Block \# | Personnel    | Do not complete any of these blocks.       |
| 23       | Use Only.    |                                            |
|          |              |                                            |
| -- 29    |              |                                            |
+----------+--------------+--------------------------------------------+

Per 5 CFR 451.103 (c ) (2) An agency award program shall provide for
[documenting justification]{.underline} for awards that are not based on
a rating of record (i.e., performance award) . Therefore, ALL awards not
based on a rating of record require written justification to be attached
to the AD 287-2.