UNITED STATES OF AMERICA

MERIT SYSTEMS PROTECTION BOARD 

JACK C. WANG,

Appellant,

v.

DEPARTMENT OF HOMELAND 

SECURITY,

Agency.

DOCKET NUMBER

DC-315H-18-0660-I-1

DATE: July 26, 2023

THIS FINAL ORDER IS NONPRECEDENTIAL1

Jack C. Wang, Gaithersburg, Maryland, pro se.

James Read, Washington, D.C., for the agency.

Patrick D. Dyson, Esquire, Orange, California, for the agency.

BEFORE

Cathy A. Harris, Vice Chairman

Raymond A. Limon, Member

FINAL ORDER

¶1 This case is before the Board on the appellant’s petition for review of the 

initial decision that dismissed the appeal of his termination for lack of 

jurisdiction. For the reasons set forth below, we REVERSE the initial decision, 

 

1 A nonprecedential order is one that the Board has determined does not add 

significantly to the body of MSPB case law. Parties may cite nonprecedential orders, 

but such orders have no precedential value; the Board and administrative judges are not 

required to follow or distinguish them in any future decisions. In contrast, a 

precedential decision issued as an Opinion and Order has been identified by the Board 

as significantly contributing to the Board’s case law. See 5 C.F.R. § 1201.117(c).
2

find that the Board does have jurisdiction over this appeal, and REVERSE the 

agency’s action, retroactively restoring the appellant to his position.

BACKGROUND

¶2 On September 18, 2016, the appellant was appointed to the excepted service 

position of Immigration Analyst (IA), GS-9, in the Asylum Division of the 

agency’s U.S. Citizenship and Immigration Services (USCIS). The appointment 

was intended to continue for 2 years. Initial Appeal File (IAF), Tab 26; Tab 9 

at 70. While so employed, he applied for another position within USCIS and was 

selected, resulting in his reassignment on August 20, 2017, to the excepted 

service position of Supervisory CIS Assistant (SCISA), GS-9. This position was 

also intended to continue for 2 years. IAF, Tab 9 at 69. Three months later, the 

appellant applied for another position and was again selected, resulting in his 

conversion on November 26, 2017, to a career-conditional competitive service 

position, Program Analyst (PA), GS-11, in the agency’s Office of Inspector 

General (OIG).2 Id. at 68. On June 13, 2018, the Acting Counsel to the OIG 

notified the appellant that he would be terminated during his probationary period, 

effective that day, for failure to perform his duties in an acceptable manner, 

specifically, for endeavoring to use his official position to secure, for personal 

reasons, documents he was otherwise unable to obtain. Id. at 36, 35. The agency 

informed the appellant that he had only limited Board appeal rights because of his 

probationary status. Id. at 38.

¶3 On appeal, the appellant argued that he was not a probationary employee 

when he was terminated because, prior to his appointment to the PA position, he 

had already completed more than 1 year of current continuous service based on 

his time in the GS-9 positions. IAF, Tab 1 at 6. On that basis, he argued, he was 

 

2

The Standard Form 50 showing the appellant’s appointment to this position initially 

indicated that he had completed a probationary period, IAF, Tab 9 at 68, but it was 

subsequently corrected to show that the appointment was subject to the completion of a 

1-year probationary period beginning November 26, 2017. Id. at 31.
3

entitled to the due process rights of an “employee” under 5 U.S.C. 

§ 7511(a)(1)(A). Id.; IAF, Tab 8 at 5. The agency contended that the appellant 

was not an “employee” because, immediately preceding his termination, he had 

not completed 1 year of current continuous service in the competitive service 

without a break in service of a workday, and that his prior service could not be 

tacked onto his current service to meet the requirement of a 1-year probationary 

period because it was not in the same line of work. IAF, Tab 9 at 10. 

Accordingly, the agency urged that the appeal be dismissed for lack of 

jurisdiction because the appellant was a probationary employee when he was 

terminated and failed to make a nonfrivolous allegation of discrimination based 

on partisan politics or marital status. 5 C.F.R. § 315.806(b); IAF, Tab 9 at 10-12, 

16; Tab 10.

¶4 In an order to show cause, the administrative judge advised the appellant of 

how he could show that he was an “employee” entitled to appeal his removal to 

the Board3and if he was not, how he could also show that he had completed his 

probationary period by tacking on prior service. IAF, Tab 13. In his response, 

the appellant argued that his previous service in the GS-9 positions could be 

tacked on to his service in the position from which he was terminated because 

they were all in the same line of work. IAF, Tab 14. 

¶5 The administrative judge found it undisputed that, at the time of his 

removal, the appellant had not completed 1 year of service in the competitive 

service appointment from which he was terminated and that his prior two

appointments were to positions in the excepted service. IAF, Tab 18. Regarding 

his claim that his prior service could be tacked on to meet the 1-year requirement 

for completion of his probationary period, the administrative judge found that he 

 

3

In so doing, the administrative judge stated that the appellant was required to show 

that, immediately preceding the adverse action, he had completed at least 1 year of 

current continuous service in the competitive service without a break in service 

(emphasis added). IAF, Tab 13 at 3.
4

had raised a nonfrivolous allegation, sufficient to proceed to a jurisdictional 

hearing. Id. The parties made additional submissions, IAF, Tabs 24-25, after 

which the administrative judge determined that the issue to be resolved was 

whether the appellant established by preponderant evidence that his prior 

excepted service positions were in the same line of work as the competitive 

service position from which he was terminated. IAF, Tab 26.

¶6 The administrative judge issued an initial decision in which she dismissed 

the appeal for lack of jurisdiction finding that the appellant was an individual in 

the competitive service with less than 1 year of service at the time of his 

termination. IAF, Tab 28, Initial Decision (ID) at 5. The administrative judge 

further found that his previous service in the two excepted service positions could 

not be tacked on to his service in his competitive service position so as to 

complete the requirement of a 1-year probationary period because the appellant’s 

prior excepted service appointments were not in the same line of work as his 

competitive service Program Analyst position. ID at 5-13. Because the 

administrative judge found that the appellant was serving a probationary period at 

the time of his termination, she determined that he could only appeal his 

termination if he made a nonfrivolous allegation that the termination was based 

on partisan political reasons or marital status, and that, because he did not allege 

either of these reasons as grounds for his termination, the Board lacked 

jurisdiction over the appeal. 5 C.F.R. § 315.806(b); ID at 13-14. Accordingly, 

she dismissed the appeal on that basis. ID at 1, 14.

¶7 The appellant has filed a petition for review, Petition for Review (PFR)

File, Tab 1, the agency has responded, PFR File, Tab 3, and the appellant has 

replied. PFR File, Tab 4.
5

ANALYSIS

The appellant is an employee under 5 U.S.C. § 7511(a)(1)(A)(ii).

¶8 The Board’s jurisdiction is not plenary; it is limited to those matters over 

which it has been given jurisdiction by law, rule, or regulation. Maddox v. Merit 

Systems Protection Board, 759 F.2d 9, 10 (Fed. Cir. 1985). The appellant must 

prove by preponderant evidence that the Board has jurisdiction over his appea l. 

5 C.F.R. § 1201.56(a)(2)(i). For the Board to have jurisdiction over an appeal 

from a competitive service termination, the appellant must: (i) not be serving a 

probationary or trial period under an initial appointment; or (ii) have completed 

1 year of current continuous service under other than a temporary appointment 

limited to 1 year or less. 5 U.S.C. §§ 7511(a)(1)(A), 7512(1), 7513(d). The U.S. 

Court of Appeals for the Federal Circuit has held that an individual who is 

excluded from “employee” status under 5 U.S.C. § 7511(a)(1)(A)(i) is 

nevertheless an “employee” if the individual meets the definition of “employee” 

under 5 U.S.C. § 7511(a)(1)(A)(ii). McCormick v. Department of the Air Force, 

307 F.3d 1339, 1342-43 (Fed. Cir. 2002). Accordingly, a competitive service 

employee serving a probationary or trial period may appeal to the Board if he has 

completed 1 year of current continuous service under other than a temporary 

appointment limited to 1 year or less.

¶9 Contrary to the agency’s argument below, the appellant’s two excepted 

appointments were not temporary. A review of their Standard Forms 50 shows 

that they were “conditional” in that they were subject to completion of a trial 

period, and that neither had a not-to-exceed date. IAF, Tab 9 at 70, 69. The fact 

that an appointment has a trial period does not make it a temporary appointment. 

A temporary appointment, by its very nature, would not require a probationary or 

trial period. See Johnson v. Department of Veterans Affairs, 99 M.S.P.R. 362, ¶ 9 

(2005) (observing that an individual with a temporary appointment was not 

required to serve a probationary or trial period).
6

¶10 As noted, under 5 U.S.C. § 7511(a)(1)(A)(ii), a competitive service 

employee serving a probationary or trial period may appeal to the Board if he has 

completed 1 year of current continuous service under other than a temporary 

appointment limited to 1 year or less. The Board has found that current 

continuous service need not be in the same or similar positions for an individual 

in the competitive service to qualify as an “employee” under 

section 7511(a)(1)(A)(ii). Claiborne v. Department of Veterans Affairs, 

118 M.S.P.R. 491, ¶ 6 (2012). The Board has also found that, for competitive 

service employees, “current continuous service” means a period of employment 

or service immediately preceding an adverse action without a break in Federal 

civilian employment of a workday. Id. In addition, the Board has interpreted that 

phrase to include prior service in either the competitive or excepted service.4 

Fitzgerald v. Department of the Air Force, 108 M.S.P.R. 620, ¶ 10 (2008). There 

is no evidence in the record that the appellant had any break in Federal civilian 

employment of a workday between the date of his first excepted appointment on 

September 18, 2016, and his termination on June 13, 2018. IAF, Tab 9 at 70, 69, 

68, 35. He worked in the excepted service position of a GS-9 IA from 

September 18, 2016, to August 19, 2017, and in the excepted service position of a 

GS-9 SCISA from August 20, 2017, to November 25, 2017, and in the 

competitive service as a GS-11 PA from November 26, 2017, until his termination 

on June 13, 2018. Thus, the appellant completed more than 1 year of current 

continuous service under other than a temporary appointment limited to 1 year or 

less immediately preceding his termination from his competitive service 

 

4

To the extent the administrative judge stated or suggested that the appellant’s service 

in the GS-9 positions could not, by virtue of their excepted service status, be considered 

in determining whether he had completed 1 year of current continuous service, see, e.g., 

IAF, Tab 13 at 3, Tab 18 at 3, Tab 26 at 2-3, she erred. Fitzgerald v. Department of the 

Air Force, 108 M.S.P.R. 620, ¶ 10 (2008). However, in view of our findings in this 

decision, and the ultimate disposition, any such error did not prejudice the appellant’s 

substantive rights. Panter v. Department of the Air Force, 22 M.S.P.R. 281, 282 

(1984).
7

appointment without a break in Federal civilian employment of a workday, and he 

therefore qualifies as an “employee” as defined by 5 U.S.C. § 7511(a)(1)(A)(ii) 

with Board appeal rights.5

¶11 An agency’s failure to provide a public tenured employee with an 

opportunity to present a response, either in person or in writing, to an appealable 

agency action that deprives him of his property right in his employment 

constitutes an abridgement of his constitutional right to minimum due process of 

law, i.e., prior notice and an opportunity to respond. Cleveland Board of 

Education v. Loudermill, 470 U.S. 532, 546 (1985). Here, the agency notified the 

appellant on June 13, 2018, that his employment was being terminated that same 

date. IAF, Tab 9 at 36. He was not provided an opportunity to respond until after 

his termination. Id. at 38-40. Therefore the agency’s termination procedures did 

not provide him with his constitutional right to minimum due process of law. 

Accordingly, the agency’s action must be reversed. See Claiborne, 118 M.S.P.R. 

491, ¶ 8 (reversing an agency’s action where the appellant was not provided with 

an opportunity to respond to the charges).

ORDER

¶12 We ORDER the agency to cancel the appellant’s termination and to restore 

him effective June 13, 2018. See Kerr v. National Endowment for the Arts, 

726 F.2d 730 (Fed. Cir. 1984). The agency must complete this action no later 

than 20 days after the date of this decision.

¶13 We also ORDER the agency to pay the appellant the correct amount of back 

pay, interest on back pay, and other benefits under the Office of Personnel 

Management’s regulations, no later than 60 calendar days after the date of this 

 

5

In light of this conclusion, we need not address the appellant’s claim on review that 

the administrative judge erred in finding that the appellant’s prior service could not be 

tacked on to his current service to meet the 1-year probationary period requirement, 

which would otherwise have rendered him an “employee” under 5 U.S.C. 

§ 7511(a)(1)(A)(i).
8

decision. We ORDER the appellant to cooperate in good faith in the agency’s 

efforts to calculate the amount of back pay, interest, and benefits due, and to 

provide all necessary information the agency requests to help it carry out the 

Board’s Order. If there is a dispute about the amount of back pay, interest due, 

and/or other benefits, we ORDER the agency to pay the appellant the undisputed 

amount no later than 60 calendar days after the date of this decision. 

¶14 We further ORDER the agency to tell the appellant promptly in writing 

when it believes it has fully carried out the Board’s Order and of the actions it has 

taken to carry out the Board’s Order. The appellant, if not notified, should ask 

the agency about its progress. See 5 C.F.R. § 1201.181(b).

¶15 No later than 30 days after the agency tells the appellant that it has fully 

carried out the Board’s Order, the appellant may file a petition for enforcement 

with the office that issued the initial decision in this appeal if the appellant 

believes that the agency did not fully carry out the Board’s Order. The petition 

should contain specific reasons why the appellant believes that the agency has not

fully carried out the Board’s Order, and should include the dates and results of 

any communications with the agency. 5 C.F.R. § 1201.182(a).

¶16 For agencies whose payroll is administered by either the National Finance 

Center of the Department of Agriculture (NFC) or the Defense Finance and 

Accounting Service (DFAS), two lists of the information and documentation 

necessary to process payments and adjustments resulting from a Board decision 

are attached. The agency is ORDERED to timely provide DFAS or NFC with all 

documentation necessary to process payments and adjustments resulting from the 

Board’s decision in accordance with the attached lists so that payment can be 

made within the 60-day period set forth above.
9

NOTICE TO THE APPELLANT

REGARDING YOUR RIGHT TO REQUEST

ATTORNEY FEES AND COSTS

You may be entitled to be paid by the agency for your reasonable attorney 

fees and costs. To be paid, you must meet the requirements set out at Title 5 of 

the United States Code (U.S.C.), sections 7701(g), 1221(g) or 1214(g). The 

regulations may be found at 5 C.F.R. §§ 1201.201, 1202.202, and 1201.203. If 

you believe you meet these requirements, you must file a motion for attorney fees 

and costs WITHIN 60 CALENDAR DAYS OF THE DATE OF THIS DECISION. 

You must file your motion for attorney fees and costs with the office that issued 

the initial decision on your appeal. 

NOTICE OF APPEAL RIGHTS6

You may obtain review of this final decision. 5 U.S.C. § 7703(a)(1). By 

statute, the nature of your claims determines the time limit for seeking such 

review and the appropriate forum with which to file. 5 U.S.C. § 7703(b). 

Although we offer the following summary of available appeal rights, the Merit 

Systems Protection Board does not provide legal advice on which option is most 

appropriate for your situation and the rights described below do not represent a 

statement of how courts will rule regarding which cases fall within their 

jurisdiction. If you wish to seek review of this final decision, you should 

immediately review the law applicable to your claims and carefully follow all 

filing time limits and requirements. Failure to file within the applicable time 

limit may result in the dismissal of your case by your chosen forum. 

Please read carefully each of the three main possible choices of review 

below to decide which one applies to your particular case. If you have questions 

 

6

Since the issuance of the initial decision in this matter, the Board may have updated 

the notice of review rights included in final decisions. As indicated in the notice, the 

Board cannot advise which option is most appropriate in any matter.
10

about whether a particular forum is the appropriate one to review your case, you 

should contact that forum for more information. 

(1) Judicial review in general. As a general rule, an appellant seeking 

judicial review of a final Board order must file a petition for review with the U.S. 

Court of Appeals for the Federal Circuit, which must be received by the court 

within 60 calendar days of the date of issuance of this decision. 5 U.S.C. 

§ 7703(b)(1)(A). 

If you submit a petition for review to the U.S. Court of Appeals for the 

Federal Circuit, you must submit your petition to the court at the 

following address: 

U.S. Court of Appeals 

for the Federal Circuit 

717 Madison Place, N.W. 

Washington, D.C. 20439 

Additional information about the U.S. Court of Appeals for the Federal 

Circuit is available at the court’s website, www.cafc.uscourts.gov. Of particular 

relevance is the court’s “Guide for Pro Se Petitioners and Appellants,” which is 

contained within the court’s Rules of Practice, and Forms 5, 6, 10, and 11. 

If you are interested in securing pro bono representation for an appeal to 

the U.S. Court of Appeals for the Federal Circuit, you may visit our website at 

http://www.mspb.gov/probono for information regarding pro bono representation 

for Merit Systems Protection Board appellants before the Federal Circuit. The 

Board neither endorses the services provided by any attorney nor warrants that 

any attorney will accept representation in a given case. 

(2) Judicial or EEOC review of cases involving a claim of 

discrimination. This option applies to you only if you have claimed that you 

were affected by an action that is appealable to the Board and that such action 

was based, in whole or in part, on unlawful discrimination. If so, you may obtain 
11

judicial review of this decision—including a disposition of your discrimination 

claims—by filing a civil action with an appropriate U.S. district court (not the 

U.S. Court of Appeals for the Federal Circuit), within 30 calendar days after you 

receive this decision. 5 U.S.C. § 7703(b)(2); see Perry v. Merit Systems 

Protection Board, 582 U.S. 420 (2017). If you have a representative in this case, 

and your representative receives this decision before you do, then you must file 

with the district court no later than 30 calendar days after your representative

receives this decision. If the action involves a claim of discrimination based on 

race, color, religion, sex, national origin, or a disabling condition, you may be 

entitled to representation by a court-appointed lawyer and to waiver of any 

requirement of prepayment of fees, costs, or other security. See 42 U.S.C. 

§ 2000e-5(f) and 29 U.S.C. § 794a. 

Contact information for U.S. district courts can be found at their r espective 

websites, which can be accessed through the link below: 

http://www.uscourts.gov/Court_Locator/CourtWebsites.aspx. 

Alternatively, you may request review by the Equal Employment 

Opportunity Commission (EEOC) of your discrimination claims only, excluding 

all other issues. 5 U.S.C. § 7702(b)(1). You must file any such request with the 

EEOC’s Office of Federal Operations within 30 calendar days after you receive

this decision. 5 U.S.C. § 7702(b)(1). If you have a representative in this case, 

and your representative receives this decision before you do, then you must file 

with the EEOC no later than 30 calendar days after your representative receives

this decision. 

If you submit a request for review to the EEOC by regular U.S. mail, the 

address of the EEOC is: 

Office of Federal Operations 

Equal Employment Opportunity Commission 

P.O. Box 77960 

Washington, D.C. 20013 
12

If you submit a request for review to the EEOC via commercial delivery or 

by a method requiring a signature, it must be addressed to: 

Office of Federal Operations 

Equal Employment Opportunity Commission 

131 M Street, N.E. 

Suite 5SW12G 

Washington, D.C. 20507 

(3) Judicial review pursuant to the Whistleblower Protection 

Enhancement Act of 2012. This option applies to you only if you have raised 

claims of reprisal for whistleblowing disclosures under 5 U.S.C. § 2302(b)(8) or 

other protected activities listed in 5 U.S.C. § 2302(b)(9)(A)(i), (B), (C), or (D). 

If so, and your judicial petition for review “raises no challenge to the Board’s 

disposition of allegations of a prohibited personnel practice described in 

section 2302(b) other than practices described in section 2302(b)(8), or 

2302(b)(9)(A)(i), (B), (C), or (D),” then you may file a petition for judicial 

review either with the U.S. Court of Appeals for the Federal Circuit or any court 

of appeals of competent jurisdiction. 7The court of appeals must receive your 

petition for review within 60 days of the date of issuance of this decision. 

5 U.S.C. § 7703(b)(1)(B). 

If you submit a petition for judicial review to the U.S. Court of Appeals for 

the Federal Circuit, you must submit your petition to the court at the 

following address: 

 

7

The original statutory provision that provided for judicial review of certain 

whistleblower claims by any court of appeals of competent jurisdiction expired on 

December 27, 2017. The All Circuit Review Act, signed into law by the President on 

July 7, 2018, permanently allows appellants to file petitions for judicial review of 

MSPB decisions in certain whistleblower reprisal cases with the U.S. Court of Appeals 

for the Federal Circuit or any other circuit court of appeals of competent jurisdiction. 

The All Circuit Review Act is retroactive to November 26, 2017. Pub. L. No. 115-195, 

132 Stat. 1510. 
13

U.S. Court of Appeals 

for the Federal Circuit 

717 Madison Place, N.W. 

Washington, D.C. 20439 

Additional information about the U.S. Court of Appeals for the Federal 

Circuit is available at the court’s website, www.cafc.uscourts.gov. Of particular 

relevance is the court’s “Guide for Pro Se Petitioners and Appellants,” which is 

contained within the court’s Rules of Practice, and Forms 5, 6, 10, and 11. 

If you are interested in securing pro bono representation for an appeal to 

the U.S. Court of Appeals for the Federal Circuit, you may visit our website at 

http://www.mspb.gov/probono for information regarding pro bono representation 

for Merit Systems Protection Board appellants before the Federal Circuit. The 

Board neither endorses the services provided by any attorney nor warrants that 

any attorney will accept representation in a given case. 

Contact information for the courts of appeals can be found at their 

respective websites, which can be accessed through the link below: 

http://www.uscourts.gov/Court_Locator/CourtWebsites.aspx.

FOR THE BOARD:

Washington, D.C.

 /s/ for 

Jennifer Everling

Acting Clerk of the Board
DEFENSE FINANCE AND ACCOUNTING SERVICE

Civilian Pay Operations

DFAS BACK PAY CHECKLIST

The following documentation is required by DFAS Civilian Pay to compute and pay back pay 

pursuant to 5 CFR § 550.805. Human resources/local payroll offices should use the following 

checklist to ensure a request for payment of back pay is complete. Missing documentation may 

substantially delay the processing of a back pay award. More information may be found at: 

https://wss.apan.org/public/DFASPayroll/Back%20Pay%20Process/Forms/AllItems.aspx. 

NOTE: Attorneys’ fees or other non-wage payments (such as damages) are paid by 

vendor pay, not DFAS Civilian Pay. 

☐ 1) Submit a “SETTLEMENT INQUIRY - Submission” Remedy Ticket. Please identify the 

specific dates of the back pay period within the ticket comments. 

Attach the following documentation to the Remedy Ticket, or provide a statement in the ticket 

comments as to why the documentation is not applicable: 

☐ 2) Settlement agreement, administrative determination, arbitrator award, or order. 

☐ 3) Signed and completed “Employee Statement Relative to Back Pay”. 

☐ 4) All required SF50s (new, corrected, or canceled). ***Do not process online SF50s 

until notified to do so by DFAS Civilian Pay.*** 

☐ 5) Certified timecards/corrected timecards. ***Do not process online timecards until 

notified to do so by DFAS Civilian Pay.*** 

☐ 6) All relevant benefit election forms (e.g. TSP, FEHB, etc.). 

☐ 7) Outside earnings documentation. Include record of all amounts earned by the employee 

in a job undertaken during the back pay period to replace federal employment. 

Documentation includes W-2 or 1099 statements, payroll documents/records, etc. Also, 

include record of any unemployment earning statements, workers’ compensation, 

CSRS/FERS retirement annuity payments, refunds of CSRS/FERS employee premiums, 

or severance pay received by the employee upon separation. 

Lump Sum Leave Payment Debts: When a separation is later reversed, there is no authority 

under 5 U.S.C. § 5551 for the reinstated employee to keep the lump sum annual leave payment 

they may have received. The payroll office must collect the debt from the back pay award. The 

annual leave will be restored to the employee. Annual leave that exceeds the annual leave 

ceiling will be restored to a separate leave account pursuant to 5 CFR § 550.805(g).
NATIONAL FINANCE CENTER CHECKLIST FOR BACK PAY CASES

Below is the information/documentation required by National Finance Center to process 

payments/adjustments agreed on in Back Pay Cases (settlements, restorations) or as ordered by the Merit 

Systems Protection Board, EEOC, and courts. 

1. Initiate and submit AD-343 (Payroll/Action Request) with clear and concise information describing 

what to do in accordance with decision. 

2. The following information must be included on AD-343 for Restoration: 

a. Employee name and social security number. 

b. Detailed explanation of request. 

c. Valid agency accounting. 

d. Authorized signature (Table 63). 

e. If interest is to be included. 

f. Check mailing address. 

g. Indicate if case is prior to conversion. Computations must be attached. 

h. Indicate the amount of Severance and Lump Sum Annual Leave Payment to be collected 

(if applicable). 

Attachments to AD-343 

1. Provide pay entitlement to include Overtime, Night Differential, Shift Premium, Sunday Premium, 

etc. with number of hours and dates for each entitlement (if applicable). 

2. Copies of SF-50s (Personnel Actions) or list of salary adjustments/changes and amounts. 

3. Outside earnings documentation statement from agency. 

4. If employee received retirement annuity or unemployment, provide amount and address to 

return monies. 

5. Provide forms for FEGLI, FEHBA, or TSP deductions. (if applicable)

6. If employee was unable to work during any or part of the period involved, certification of the type of 

leave to be charged and number of hours. 

7. If employee retires at end of Restoration Period, provide hours of Lump Sum Annual Leave to 

be paid. 

NOTE: If prior to conversion, agency must attach Computation Worksheet by Pay Period and required 

data in 1-7 above. 

The following information must be included on AD-343 for Settlement Cases: (Lump Sum Payment, 

Correction to Promotion, Wage Grade Increase, FLSA, etc.) 

a. Must provide same data as in 2, a-g above. 

b. Prior to conversion computation must be provided. 

c. Lump Sum amount of Settlement, and if taxable or non-taxable. 

If you have any questions or require clarification on the above, please contact NFC’s Payroll/Personnel 

Operations at 504-255-4630.