NPS Administratively Determined (AD)

 Hiring Guide (March 2023)

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 National Park Service

 Administratively Determined (AD) Hiring Guide

AD personnel may be hired:

* to cope with a sudden and unexpected emergency caused by a fire, or extreme fire potential, 

flood, storm, or any other all-hazard emergency that threatens damage to federally protected 

property, has the potential to cause loss of life, serious injury, public health risk, or damage to 

natural or cultural resources unless brought under immediate control.

* to provide emergency assistance to States under formalized agreements.

* to meet mission assignments issued by the Federal Emergency Management Agency (FEMA).

Considerations before hiring:

* AD hiring is purely temporary in duration and must be terminated when other employment 

methods can be initiated.

* Ensure that the circumstances of hire meet the guidance found in Section D of the DOI AD Pay 

Plan (provide support to ongoing incident, pre-position resources, hire personnel during 

unusually dry periods or local very high fire danger, temporarily replace assigned fire 

resources, attend/instruct emergency training, carry out emergency stabilization work where 

there is immediate danger to loss of life or property, to hire casuals for prescribed fire 

projects authorized by congressional funding within the wildland fire operations account,

etc.).

* Ensure the conditions of hire meet the guidance found in Section E of the DOI AD Pay Plan.

* AD employees hired under this plan must meet minimum physical fitness standards, security, 

and qualification requirements as established by agency policy. Hiring units shall use the 

Single Resource Casual Hire Information Form (PMS 934), per agency policy. In addition, 

casuals are required to complete agency-specific health and medical screening requirements 

for certain positions prior to being hired.

* This authority cannot be used to circumvent other hiring authorities, such as temporary 1039 

appointments or career seasonal appointments.

* AD employees under this Pay Plan cannot supervise, hire, order, or recommend payments 

thatin any way affect a company or contractor that the casual has ownership or employment 

with, or perform any other financial responsibilities to or for the company or contractor on an 

incident. If such working conditions exist on an incident or other workplace, the casual 

employee must immediately disclose any relationship with the company or contractor to the 

Agency Administrator, Incident Business Advisor, or Finance/Administration Section Chief for 

immediate action.

* Hiring units shall adhere to agency-specific policy on hiring relatives as casuals.

* Ensure AD pay rates are applied based on Section F (Position Classification) of DOI AD Pay

Plan.
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* The agency administrator or designee has the final authority to accept or reject any person 

hired under this PayPlan.

Hiring Unit Responsibilities

* Refer to the current DOI AD Pay Plan for the AD positions and the hourly pay levels. 

* All necessary forms can be found at Casual Payment Center | National Interagency Fire Center 

(nifc.gov)

Employment Eligibility Verification (I-9): Complete every 3 years. The form requires physical 

examination of specific documents within three days of hire and must be completed by casual 

employee on the first day worked. Page three of the form provides a list of acceptable documents. 

Common acceptable documents are passports or state issued driver’s license and social security card

(SSN). For example, if the employee brings in their driver's license and social security card, complete 

columns B & C. The I-9 stays on file at the hiring unit and is not sent to the Casual Payment Center 

(CPC).

Employees Withholding Allowance Certificate (W-4): Updated, sign and submit annually. A copy of 

the W-4 is sent with the first OF-288 of the year to CPC. If Federal W-4 is utilized by a State, please 

notate “State & Federal” on the form.

State Tax Form: Update, sign and submit annually if required for withholding of state income taxes. A 

copy of the state tax form is sent with the first OF-288 of the year to CPC.

Direct Deposit Sign-Up Form (SF-1199A): Self-explanatory. The form needs to be sent with the first 

OF-288 of the year to CPC.

NWCG Single Resource Casual Hire Information form (PMS 934): Complete before each 

assignment/incident to ensure the casual employee understands the position they are hired into and 

the hourly rate they will be paid. The single resource casual employee shall give the incident a copy of 

the form along with their Crew Time Report (CTR). This form is a hiring document; a copy remains on 

file at the hiring unit and is not sent to the CPC. 

Incident Behavior form (PMS 935-1): Complete before each assignment/incident so the casual 

employee has been notified of the expected behavior for all employees at the incident. This form is 

required for single resource and crew employees. This is a hiring document; a copy remains on file at 

the hiring unit and is not sent to CPC.

DOI Conditional Offer of Federal Employee Health Benefits form: Complete annually, even if the 

employee declines or is a federal or state retiree and declines. The casual will need to read, check one 

of the boxes, and sign. The form needs to be sent with the first OF-288 of the year to CPC.
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Employee Common Identifier (ECI): Employee social security numbers are no longer used on Incident 

Time Reports (OF-288). Each employee is given a generated unique identifying number. The ECI is 

entered in FPPS by CPC. To request a number for a new casual, the ECI request form can be found at 

the CPC website: 

Casual Payment Center | National Interagency Fire Center (nifc.gov). 

Once the form is completed and either faxed or emailed (thru Bison Connect) to the CPC, they'll 

provide you with the ECI, which needs to be written on the OF-288 before it's sent to the CPC for 

payment.

Approving Official Batch Memo: Every batch of casual payments is assigned a unit batch number by 

the hiring unit. It is recommended for hiring units to keep a log of batches processed to eliminate 

duplicate numbering. Any conversations with CPC regarding the batch contents will reference the unit 

batch number. Complete the batch memo manifest, notate forms attached, and sign by an authorized 

Approving Official. The memo serves as a cover letter for the attached OF-288s sent to the CPC.

Incident Time Report (OF-288): The casual employee records times worked on Crew Time Report

(CTR) signed by the incident supervisor. The Incident Time Report is a summary of submitted CTRs. 

Completed OF-288s include Position Code, AD Class and AD Rate. Verify hours total in each column, 

accounting codes are complete, and remarks noted for changes on the record. The accounting code in 

box 15 must include Cost center: 10-digit alpha/numeric (e.g., PPWOVPADD3)

Functional area: 15-digit alpha/numeric (e.g., PF25050DS.WW0000)

WBS: 14-digit work breakdown structure (e.g., PF.FSAZA1D23.00.1)

The form shall be signed by the casual employee and incident TIME Unit Leader. 

Casual Employee Responsibilities

* Complete required forms, provide current identification documents and banking information.

* Retain the Single Resource Casual Hire Information form, copy of the Incident Behavior form, 

and a copy of the AD Pay Plan. 

* Provide to the TIME Unit, CTRs and Single Resource Casual Hire Information form

* Casual Crews will provide a complete manifest to the TIME Unit.

* Review timesheets thoroughly before signing.

Processing Timesheets by the CPC

Sending payment documentation to the CPC

* Hiring units email batch memos, timesheets, and payment forms (W-4, direct deposit form, 

FEHB form) through BisonConnect (your government email account), which allows the 

employees to get paid within 1-3 days of emailing and saves on shipping charges. 
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* Electronic signatures generated through a PIV card are accepted on the batch memos.

* Once the CPC receives the emailed packet, a confirmation email verifying the documents were 

received will be sent to the hiring unit for tracking purposes.

* Payment Packet contents

Approving Batch Memo

Batch Manifest

Per Casual Employee:

▪ OF-288

▪ W-4 (First Payment)

▪ State Tax form, if applicable (First Payment)

▪ Direct Deposit Form (First Payment or Request to Change)

▪ DOI Conditional Offer FEHB Form (First Payment)

▪ Travel Worksheet, if applicable

However, please note that:

* Any documents containing Personally Identifiable Information (PII) (SSNs, personal addresses, 

personal phone numbers, date of birth, etc.) can be emailed to the DOI Casual Payment 

Center AS LONG AS the BisonConnect email system is being used to and from another DOI 

agency. 

* AS A REMINDER: DO NOT USE PERSONAL EMAIL ACCOUNTS TO EMAIL ANY FORMS 

CONTAINING PII TO THE CASUAL PAY CENTER (oranywhere else!).

AD Employee Training

AD employees are entitled to 80 hours of training per calendar year regardless of agency worked at. 

For instance, if an AD employee worked for the BIA and was sent to training in February, then 

transferred to the NPS in April, any hours in training while with the BIA would count against the 80-

hour annual cap. 

Training for AD employees also includes attending IMT meetings, typically held each spring. The 80 

hours’ cap does not include hours in travel status.

AD training includes tuition, travel costs to and from, and hours in training and will be reimbursed 

through the current-fiscal-year AZA1 WBS. Please reference the national suppression incident 

spreadsheet for the full cost code. The spreadsheet can be found at LINK HERE.
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Although AD employees are guaranteed 8 hours paid each day while away from their home unit, the 

NPS has made the decision that, while in training or instructing status, AD employees will only be paid 

for actual hours in training/instructing mode. If an AD employee attends S-260 training that covers 20 

hours over 3 days, the AD employee will only be reimbursed for the 4 hours on day 3, rather than the 

guaranteed 8 hours. 

Reference the section on AD Employee Travel for any questions specific to travel to and from training.

Hiring AD Employees to Instruct

AD employees are capped at 120 hours per calendar year for instructing regardless of agency. As with 

training, any hours in travel status to and from are not included in the 120-hour cap. The NPS does not 

guarantee 8 hours paid for each day the AD employee is away from the hiring unit. As with the training 

hours, if an AD employee spends only 4 hours instructing on day 3, the NPS will only pay for the 4 

hours of instructing. 

AD employees with emergency medical technician (EMT) qualifications may be hired to support work 

capacity tests and training courses. Time worked shall be charged to the training code. 

Hiring Relatives as AD Employees

AD hiring officials have the responsibility of complying with the AD hiring authority and following DOI 

ethics rules and regulations. Per the DOI Ethics Guide (DOI Ethics https://www.doi.gov/ethics):

Giving Preferential Treatment to Relatives: Nepotism, or showing favoritism on the basis of family 

relationships, is prohibited. The Department's policy on nepotism is based directly on the nepotism law 

in 5 U.S.C. § 3110. A public official may not appoint, employ, promote, advance, or advocate for the 

appointment, employment, promotion, or advancement of a relative in or to any civilian position in the 

agency in which the public official serves, or over which he or she exercises jurisdiction or control. This 

restriction encompasses all of DOI (in addition to all DOI bureaus). An individual appointed, employed, 

promoted, or advanced in violation of the nepotism law is not entitled to pay.

In addition, the DOI AD Pay Plan states that: E.24 -- Hiring units shall adhere to agency-specific policy 

on hiring relatives as casuals. All NPS AD hiring units will abide by the DOI Ethics Guide if there is a 

question about hiring relatives. If an NPS hiring unit chooses to hire a family member as an AD 

employee, the AD employee will not be paid for any work that was done. 

There may be circumstances requiring hiring a relative as an AD employee (e.g., the AD employee is 

fully qualified as a deputy IC2 and is on an Incident Management Team). In these cases, the AD 

employee should be hired remotely by another NPS field unit, and all paperwork (including OF-288s, 

signed batch memos, etc.) should flow through and be filed at the remote office. However, there must 

be a compelling reason or need to hire a relative as an AD employee. If such a need or reason exists, 

then approval needs to go through the national office before any hiring paperwork is completed. 
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Hiring Seasonal Employees as AD Employees

Reference the dual-signed WASO-VRP/HR guidance memo dated June, 2019 that is included below. 

The Administratively Determined (AD) Pay Plan for Emergency Workers (Casuals) is a valuable hiring 

authority that is available to the National Park Service to rapidly bring on staff to respond to sudden 

and unexpected emergencies. In addition to wildfire response, use of the AD Pay Plan authority 

supports search and rescue operations, all-hazard incidents such as hurricanes and floods, and 

prescribed burns. 

From time to time, individual supervisors have been found to have used the authority inappropriately. 

In an effort to ensure that the National Park Service retains the authority to continue to use the AD Pay 

Plan in the future, information on the AD Pay Plan authority and proper application of same within the 

NPS is provided in this memo. 

The AD Pay Plan authority is to be applied wherever and whenever it becomes necessary to hire 

persons:

1. To cope with a sudden and unexpected emergency caused by a fire, or extreme fire potential, flood, 

storm, or any other all-hazard emergency that threatens damage to federally protected property, 

has the potential to cause loss of life, serious injury, public health risk, or damage to natural or 

cultural resources unless brought under immediate control. 

2. To provide emergency assistance to States under formalized agreements.

3. To meet mission assignments issued by the Federal Emergency Management Agency (FEMA).

In addition to providing the circumstances when the AD Pay Plan authority can be utilized, the AD Pay 

Plan also communicates restrictions that supervisors must comply with. Specifically called out in this 

memo are two sections that have been previously utilized inappropriately in parks:

Section D.6 of the Authority, which states: To allow personnel to attend emergency incident 

training in preparation for emergency incident response, including all-hazard training. In most 

cases, this should not exceed a total of 80 hours per calendar year, regardless of hiring agency. 

This authority cannot be used to circumvent other hiring authorities such as temporary 1039 

appointments or career seasonal appointments. The 80-hour limit includes required annual 

refresher courses. The 80-hour limit does not include travel hours.

Additionally, D.14 states: To hire casuals for prescribed fire projects for the purpose of reducing 

hazardous fuels. This does not include Mechanical or Chemical Reduction Projects. This Pay 

Plan is to be used to provide temporary support due to the unpredictable nature of prescribed 

fire activities and may not be used to circumvent normal hiring and contracting procedures.

The National Park Service is prohibited from hiring individuals under the AD Pay Plan authority to 

complete annual training requirements, support prescribed burns, or for other activities such as step-up 

after that individual has been offered and/or has accepted a federal temporary/seasonal or career 

seasonal position and is going through the pre-employment clearance process.
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It is a violation of this hiring authority to appoint temporary seasonal employees to the same or other 

positions using other hiring authorities within the service year; to extend employment beyond the 

“1039” hour limitation through the use of the AD pay plan authority; or to manipulate the AD hiring 

authority to bring employees into “pay status” before their official EOD date. 

By policy, the NPS National Incident Business Office reviews hiring actions made using the AD Pay Plan 

authority. Parks or Programs inappropriately using the AD pay plan will be responsible for covering all 

labor and/or other costs associated with this action from their park base budget. Approval for future 

use of the AD pay plan authority may be revoked if the authority was used inappropriately to 

circumvent other hiring authority restrictions.

AD Employees & Travel

As hiring officials for NPS AD employees, it's critical all travel and payroll documents are audited before 

submitting for processing/pay/reimbursement. Any travel reimbursement for AD employees must be 

managed under the Federal Travel Regulations. As with regular federal employee travel, if an AD 

employee would prefer to drive a privately-owned vehicle (POV) or rental vehicle, rather than book a 

flight and a rental car, to an incident, training or instructing, a comparison travel authorization must be 

completed and on file. POV mileage will only be reimbursed up to the cost of the airline flight. In the 

past, many NPS AD employees have chosen to drive to an incident, which has required an overnight 

stay in a hotel before reaching the incident. The comparison travel authorization should include all 

costs between driving and flying, e.g., hours paid while in travel status, per diem, and overnight 

lodging. The AD employee’s incident supervisor or Incident Commander (IC) does not have the 

authority to determine mode of travel. If an AD employee states that his incident supervisor approved 

driving a POV to an incident, the comparison travel authorization still needs to be completed. Hiring 

officials also have the option to tell the AD employee that he/she will be booked on a flight, since it

may be the most economically beneficial option for the government. 

In addition, AD employees should only be traveling by POV or rental car to an assignment if it's within a 

reasonable driving distance (less than 6 hours). If it's more than 6 hours, then the AD employee will 

need to book an airline reservation, even if it that involves fees for additional bags. There will be very 

few exceptions (e.g., the Diablos traveling by crew bus to an incident), but, for the most part, this is a 

hard-and-fast rule for NPS. When AD employees are resource-ordered for an incident, they are not 

entitled to tell anyone how they will travel to and from the assignment. Hiring officials have the 

responsibility of traveling employees by the most economically advantageous mode. 

Travel reimbursement: Under terms of the Casual Hire Travel Expense Reimbursement Waiver, casual 

employees may claim the following travel expenses on the OF-288 form:

• Privately Owned Vehicle (POV) mileage;

• Incidental expenses; and

• Maximum of 15 meals per emergency incident.

The CPC staff will validate, as accurate, the allowable per diem rate and mileage rate claim on each 

reimbursement form/request and process the OF-288 for payment. They will work with the hiring 
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location to ensure the casual’s pay on the OF-288 is not delayed pending travel reimbursement issues. 

When travel issues cannot be resolved (e.g. there are lodging or other receipts that need to be paid 

through CGE), the CPC will remove the travel claims from the OF-288 and process only the casual’s 

payroll. Please reference the CPC Casual Travel Process and forms at Casual Payment Center | National 

Interagency Fire Center (nifc.gov)

AD Employees & Planned Events: As stated in the preamble to the DOI AD Pay Plan, AD 

employees can only be hired

-- to cope with a sudden and unexpected emergency caused by a fire, or extreme fire potential, flood, 

storm, or any other all-hazard emergency that threatens damage to federally protected property, has 

the potential to cause loss of life, serious injury, public health risk, or damage to natural or cultural 

resources unless brought under immediate control. 

-- to provide emergency assistance to States under formalized agreements.

-- to meet mission assignments issued by the Federal Emergency Management Agency (FEMA).

Such hiring is of uncertain and purely temporary duration and must be terminated when other 

employment methods can be initiated. This plan does not provide the authority to hire individuals for 

out-of-country assignments.

To recap: AD employees can only be hired for emergency incidents (suppression, severity, step-up, or 

all-hazard {hurricanes, floods, mudslides, etc.}), for prescribed burns, or to attend training or provide 

instruction at a training class. AD employees cannot be hired for planned events (anniversary events 

for NPS units, POTUS visits, visits by international dignitaries, etc.). If there are any questions about 

the appropriateness of hiring AD employees for any incident or event, please contact the NPS Incident 

Business Management Specialist.

AD Employees During a Government Shutdown

All questions regarding any type of hiring or bringing back employees to work during a government 

shutdown should be referred to the Solicitor's Office for a decision. NPS field units and regional offices 

should not assume that AD employees are the fallback when other employees are furloughed. 

Working AD employees during a government shutdown could result in delays or denial of pay 

processing if not pre-approved to work. 

Hiring Federal Employees as AD Employees

Temporary seasonal employees can be hired as AD employees who are in a non-pay status 

(intermittent or furloughed status) and they are responding to an emergency incident. Permanent 

federal employees cannot be hired as AD employees if they are in leave status (annual leave, comp 

time, etc.), as they would still be in pay status. In the past, Bureau of Reclamation (BOR) and United

States Geological Survey (USGS) employees have asked NPS hiring units to hire them as ADs to mobilize 

to an incident while they were in some type of leave status. This is an inappropriate hiring practice. 

Mobilizing permanent federal employees, who do not work for Interior or Agriculture fire agencies, is 

implemented through an inter-agency agreement. The Office of Wildland Fire (OWF) has signed a
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Statement of Intent with USGS allowing OWF to reimburse USGS for any costs incurred (payroll, travel, 

supplies) on a suppression incident. The Statement of Intent is included as an attachment to this 

document. 

Minimum Age Requirements for AD Employees

Reference the NWCG Standards for Interagency Incident Business Management: 

Hiring of 16- and 17-year-olds

In accordance with applicable state and federal laws, 16- and 17-year-old persons may be hired. Obtain 

incident agency policies (state or federal) for hiring regulations at the site http://youthrules.dol.gov/.

Job Corps and Youth Conservation Corps enrollees may be hired as casuals under the AD Pay Plan. 

• Enrollees age 16 and 17 may be assigned to non-hazardous or non-arduous duties only, e.g., 

camp support.

• Enrollees age 18 and over may be assigned to all other incident duties at the appropriate AD 

pay rate. 

Exception Positions

There may be circumstances when a hiring unit needs to hire into a position that is not included on the 

Pay Plan position matrix (e.g., electrician, coroner, environmental health specialist, etc.). Exception 

position descriptions must be completed and approved before hiring AD employees into the positions. 

NPS exception position templates can be found at Agency Memos | National Interagency Fire Center 

(nifc.gov). In addition, there are approved NPS exception position descriptions located at the same 

link, so before reinventing the wheel, check to see if there’s already an approved position description

in place. Reference the DOI AD Pay Plan:

Exception positions: If there are no positions on the incident position matrix in the AD hiring plan that 

fit the scope of duties for a position needed and the extent of a current emergency necessitates unique 

skills, an exception position could be established at the AD-A, AD-B, AD-F, AD-I, or AD-K classification 

levels at the local unit by an appropriately delegated hiring official. For NPS field units, an exception 

position description form will need to be completed by a qualified hiring official, then approved at the 

national office before hiring anyone into the position. The exception position forms can be found on the 

CPC’s website. The classifications below should be used as guidelines when determining at what level a 

new position may be established:

a. Exception Position 1 – Level AD-A. Positions at this level require no specialized skills or training. 

The job requires the performance of simple routine, repetitive work tasks under close supervision or 

requires following oral or written specific step-by-step instructions.

b. Exception Position 2 – Level AD-B. Positions at this level require minimal skills or training. Routine 

assignments are carried out independently. Oral or written assignments are given with general information 

on quality, quantity, and timeframe expectations.
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c. Exception Position 3 – Level AD-F. Positions at this level require skills acquired through specific 

job training or experience. Work is performed independently. The incumbent of the position is expected to 

interpret instructions, plan work, lead or supervise positions at the next lower level.

d. Exception Position 4 – Level AD-I. Positions at this level require skills acquired through specific job 

training, technical education, or experience and require the ability to apply or use specialized, complicated 

techniques or equipment. The incumbent of this position is expected to instruct others in the requirements 

of the job, plan work, or supervise positions at the next lower level. This level requires independent 

judgment and decision making. Assignments are expected to be completed and problems resolved 

independently. 

e. Exception Position 5 – Level AD-K. Positions at this level require expert knowledge and very 

high skill level in applying a wide range of concepts, principles, and practices associated with professional 

or administrative work. Most often, the positions at this level are commensurate with knowledge gained 

from successful completion of Incident Command System (ICS) 400 level and above courses, qualifications 

at the Type 1 or 2 level, or “ologist” type positions (such as hydrologist) that require a higher level of 

education or certification. Incumbents of these positions may be required to supervise other professionals 

or a group of technical specialists (THSP).

 Exception

 position #

Classification

 level

 Pay rate

 (per hour)

 1 AD-A 17.20

 2 AD-B 18.88

 3 AD-F 27.80

 4 AD-I 37.56

 5 AD-K 45.44

For payment purposes, when completing the OF-288 (Incident Time Report), the Exception Position 

code will be recorded as a technical specialist (i.e., THSP-Exception Position 3, AD-F), with the actual 

position title (i.e., Biological Technician) documented in the remarks section. A trainee hired for an 

Exception Position will be paid at the next lower rate (i.e., THSP-Exception Position 3, Biological 

Technician/T, AD-E).

Boot Stipends

AD employees who are red-carded in either a moderate or arduous incident position are entitled to the 

annual $167 boot stipend. The DOI Casual Payment Center will automatically process the boot stipend 

for casual employees for their first qualifying assignment (suppression incident or prescribed burn 

project), so there’s no need for the hiring unit to fill out additional forms or paperwork. The CPC will 

add the stipend to the casual employee’s payment as a taxable reimbursable and track the payment to 

eliminate duplicate reimbursements. The boot stipend will be noted on the casual employee’s Wage 

and Earnings Statement. Casual boots are charged to PF.FSFBMF0XX.00.1 (the XX represents the fiscal 

year the boots was reimbursed) for suppression, severity/step-up, and emergency stabilization. 
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Medical Standards

The medical standards apply only to arduous duty wildland firefighting positions as described in PMS 

310-1. If an AD employee is currently serving in an arduous position, then he/she will be required to 

undergo a medical exam every 3 years, with self-certification in the years between as a condition of 

employment. The self-certification process will take place in the CAS system. 

Physical exams are a pre-employment requirement for wildland fire positions requiring arduous duty. 

A qualified determination on a medical exam or self-certification is required prior to hiring. Casual 

employees who are in the CAS database and have a current exam or self-certification with a cleared 

status must provide proof of being cleared using the CHS qualification certificate. Qualification 

certificates are good for one year (365 days) from the date of the exam or self-certification for hiring 

purposes and for taking the work capacity test.

Light or Moderate Duty Medical Screening Process: Effective 2/6/19, the medical screening process 

for light and moderate work capacity testing will be handled through Acuity International (Formerly 

CHS).

You can find more information about the Medical Standards Program at 

https://www.nifc.gov/medical_standards/index.html and Wildland Firefighter Medical Standards | U.S. 

Department of the Interior (doi.gov).

Casual Pay Center Contact Information

The DOI Casual Payment Center is located at the National Interagency Fire Center in Boise, ID. Their 

website contains all relevant information pertaining to Casual Hires, and CPC employees are also 

available through email at CasualPay@blm.gov or by calling 877-471-2262 or 208-387-5760. Hours of 

operation are 8:00 am to 4:00 pm MST Monday through Friday. 

File Retention

Follow the NPS Records Disposition Schedule (NPS-19, Appendix B) for filing and maintaining payroll 

and travel documents. Currently, payroll records are retained on file for 3 years, then destroyed; travel 

documents are retained for 6 years, 3 months, then destroyed. All personnel/payroll forms (W-4, I-9, 

FEHB form, etc.) should be retained until either the casual employee terminates his/her employment 

or until the forms are replaced with updated copies in the file (e.g., annual W-4).

Exhibits included in this guidance

Casual Payment Center Casual Payment Process

DOI Emergency Firefighter Payments OF-288 Audit Procedures

Batch memo w/travel costs template

Casual Travel Reimbursement Process

OF-288

Direct Deposit form

ECI Request Form
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I-9 form

W-4 form

Single Resource Casual Hire Information

Incident Behavior form

Conditional Offer of FEHB form

Health Benefits for Casuals Hiring Unit Guidance 

FEHB Fast Facts for Casuals

Statement of Intent for Incident Support – OWF-USGS

2022 NPS Implementation Guidance of Department of the Interior Wildland Firefighter Medical 

Standards Program

Please note that all hiring documents and forms can be found at Casual Payment Center | National 

Interagency Fire Center (nifc.gov)
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Medical Standards

The medical standards apply only to arduous duty wildland firefighting positions as described in PMS

310‐1.  If an AD employee is currently serving in an arduous position, then he/she will be required to

undergo a medical exam every 3 years, with self‐certification in the years between as a condition of

employment.  The self‐certification process will take place in the EAS system.   

Light or Moderate Duty Medical Screening Process:  Effective 2/6/19, the medical screening process

for light and moderate work capacity testing will be handled through Acuity International (Formerly

CHS).

You can find more information about the Medical Standards Program at  

https://www.nifc.gov/medical_standards/index.html

Casual Pay Center Contact Information

The DOI Casual Payment Center is located at the National Interagency Fire Center in Boise, ID.  Their

website contains all relevant information pertaining to Casual Hires, and CPC employees are also

available through email at CasualPay@blm.gov or by calling 877‐471‐2262 or 208‐387‐5760.  Hours of

operation are 8:00 am to 4:00 pm MST Monday through Friday.   

File Retention

Follow the NPS Records Disposition Schedule (NPS‐19, Appendix B) for filing and maintaining payroll

and travel documents.  Currently, payroll records are retained on file for 3 years, then destroyed; travel

documents are retained for 6 years, 3 months, then destroyed.  All personnel/payroll forms (W‐4, I‐9,

FEHB form, etc.) should be retained until either the casual employee terminates his/her employment

or until the forms are replaced with updated copies in the file (e.g., annual W‐4).

Exhibits included in this guidance   

Casual Payment Center Casual Payment Process

DOI Emergency Firefighter Payments OF‐288 Audit Procedures

Batch memo w/travel costs template

Casual Travel Reimbursement Process

OF‐288

Direct Deposit form

ECI Request Form

I‐9 form

W‐4 form

Single Resource Casual Hire Information

Incident Behavior form

Conditional Offer of FEHB form

Health Benefits for Casuals Hiring Unit Guidance  

FEHB Fast Facts for Casuals

Statement of Intent for Incident Support – OWF‐USGS
DOI CASUAL PAYMENT CENTER

 CASUAL PAYMENT PROCESS

 

Documents to be Completed by Hiring Official

DOCUMENTS TO COMPLETED AND KEPT AT THE HIRING UNIT:

- Form I-9: the AD completes on the first day of hire. Hiring official verifies the documents 

within 3 days of hire. This form must be completed every 3 years or when a presented 

document has expired. The Form I-9 is retained at the hiring unit.

- Incident Behavior Form: retained at the home unit.

- Single Resource Hire Form: retained at the home unit.

DOCUMENTS TO BE COMPLETED BY HIRING UNIT AND SUBMITTED TO CPC:

- Form W-4: resubmit only when information changes, or yearly for Federal exempt status.

- State Tax Form: resubmit only when information changes, or yearly for State exempt status.

- If Federal W-4 is utilized by a State, please notate State & Federal on the form.

- Tribal Tax form: submitted to the CPC each calendar year for tax exemption status

- Direct Deposit Form or Electronic Funds Transfer (EFT) Waiver form EFT Waiver submitted 

every year for a Treasury check to be issued until a direct deposit account can be opened.

- Federal Employees Health Benefits (FEHB) Conditional Offer Form: completed each calendar 

year (submitted to CPC).

AT DISPATCH HIRING OFFICIAL WILL:

-

HIRING UNIT PAYMENT RESPONSIBILITES

- Ensure work time has been recorded as outlined in the NWCG Standards for Interagency 

Incident Business Management assuring the AD Title is included in all columns and agrees 

with the Pay Plan Matrix.

- Process partial payments every two weeks, indicating partial payments in the remarks section of the OF-288.

- Complete travel time home if away from home unit upon casual’s return.

- E-ISuite timesheets: enter the Employee Common Identifier (ECI) if all 9s were printed on 

timesheet. If ECI number is unknow, contact CPC to request for individual or a report for 

hiring unit. Never use a social security number on an OF-288.

- Include travel comments on Approving Official Batch Memo, OF-288 or Travel Worksheet 

If T&A is for suppression/preparedness (a non-planned incident) and there are no receipts, 

(e.g., M&IE). If receipts are included, (e.g., meals, gas, lodging) travel must be entered 

through ETS.

CASUAL PAYMENT CENTER (CPC)

- Maintains Federal W-4, State Tax, Tribal Exemption, and Direct Deposit/EFT Waiver Forms, 

FEHB Conditional Offer, Travel Worksheets and OF-288s in the casual’s payment file. 

- Maintain a copy of the Exception Position’s description of duties documentation with the 

OF-288. 

- Process payment to the casual within 5 business days of receipt. 

- Notify hiring unit when there are questions on timesheets received.

- Notify hiring unit by email when payment has processed if requested on the Approving 

Official Memo.

CASUAL/AD RESPONSIBILITIES

• Always indicate address where 

you receive mail on all forms 

submitted to CPC (e.g., W4, 

State Tax Forms, Direct Deposit, 

etc.). If forms are incomplete or 

filled out incorrectly, they will be 

returned to the casual/agency 

without updating their profile 

information. The Federal Personnel Payroll System (FPPS) will 

automatically default taxes to 

Single marital status and Zero 

allowances for Federal & State 

taxes if forms are completed 

incorrectly.

• Bank information provided will 

be used unless the CPC is notified of any changes.

• Always review timesheets thoroughly before signing.

National Interagency Fire Center

Casual Payment Center MS 270

3833 S Development Ave 

Boise, ID 83705-5354

casualpay@blm.gov

Toll Free: (877) 471-2262 

 Fax: (208) 433-6405

 

Office hours: 8:00am – 4:00pm MT, Monday—Friday

https://www.nifc.gov/programs/casualpayment-enter
 04/2022

DOI Emergency Firefighter Payments

OF-288 Audit Procedures

Hiring Unit Reviewing Official is responsible for auditing OF-288.Official shall ensuretheOF-288 – IncidentTime 

Reports submitted for payment to DOI Casual Payment Center (CPC) are Casual Hires and that the OF-288 has 

been reviewed forthe following:

▪ Hired At: Unit Identifier Code for the location hired at (e.g., ID-BOD for Boise District, AZ-NAA for Navajo Nation).

▪ Employee Common Identifier (ECI): Must be legible and accurate. If ECIwas unknown and entered as all 9s into 

e-ISuite,cross out and enter correct ECI number. Do not use any part of the Social Security Number in the ECI 

block.

▪ Name: Legible, legal full name. No nicknames. Indicate Jr., Sr., I, II, III. Double check correct ECI when auditing for 

Jr., Sr. I, II, etc.

▪ Columns A through D: All columns with time require the following:

o Incident Name: Enter Fire Name. Check Fire Name as assigned in Fire Code. If training or instructing write 

“Training” or “Instructor”/“Lead Instructor” with course number.

o Fire Code: Enter Fire Code or Project Number. 

o Position Code: Enter Position Code (e.g., FFT2). If trainee, indicate with a T (e.g., FFT2-T).

✓ If Exception Position, include an attached description of duties (a requirement for payment), and on the 

OF-288(s) indicate the full Position Title and description matching the attached description of duties 

signed by the National Incident Business Lead (e.g., THSP Exception Position 3 Forestry Technician).

o AD Class: May be left blank, but if indicated must correspond to the Position Code listed in the AD Pay Plan. 

AD Class will automatically populate in FPPS.

o AD Rate: (e.g., $20.84) May be left blank. Rate will be populated based on current AD Pay Plan.

o Home/Hiring Unit Accounting Code: may be indicated in block 15, or in Remarks. For example:

✓ BIA: AAKK004401 AF2001010 999900 AF.SPG85Z0000.00000

✓ BLM: LLIDB00440 LF2000000 HU0000 LFSPG85Z0000

✓ NPS: PPIMIMRO2D PF200SP85 WW0000 PFFSG85Z022001

✓ FWS: FF02R2B000 FFF2000000G85Z0

o Time: Must include month, day, start and stop times, and total hours. Start and stop times must be in military 

time (2400 hrs.) and rounded to the nearest 15-minute increment. 

o Commissary and Travel: Completed for travel following the directions located in the Casual Hire TravelProcess 

(if M&IE is indicated on the OF-288).

o Remarks: Annotate position change at the incident with effective date.

o Employee Signature: Completed or noted “Unavailable for Signature” (casual’s signature not required to 

process payment).

o Time Officer (Signature): Completed with a Time Officer Signature (electronic signature accepted).

It would be helpful for the CPC to receive batches in the following order:

Each individual’s paperwork scanned in order from 1

st to last: OF-288(s) in work date order, W-4s, Direct Deposit

form/EFT Waiver, State Tax forms, and FEHB Conditional Offer form.

Submit by email (if within DOI network to casualpay@blm.gov, or by overnight mail to the Casual Payment Center with 

the Approving Official Memo that certifies timesheets are correct and ready for payment (Timesheets will not be 

processed without the Approving Official Memo).

Thank You! 

Please reference the Interagency Incident Business Management Handbook (Yellow Book), or your agency specific 

guidelines for further information.
Approving Official Batch Memo

Date: Unit Batch Number*:

(Example: ID-BOD-001)

To: Casual Payment Center MS 270

3833 S Development Ave

Boise, ID 83705-5354

(Please overnight mail / Call Casual Payment Center for Saturday delivery)

From:

Name Phone Number

Unit Address

 Check here if you would like a confirmation of processed batch sent to you.

Government Email address for batch confirmation

Subject: Payment of Casual Hire, Incident Time Reports (OF-288)

Attached are the forms necessary for processing casual hire payrolls as follows:

Number of OF-288s in Batch:

Number of Casual Names submitted (attach list):

(For Crews attach Crew Manifest)

I have verified, attached, or have on file the following:

1. OF-288s have been audited and are attached, including signatures of the casual (if available) and an 

original Time Officer signature on line 21 of the OF-288.

2. I-9s are completed and on file at the hiring unit, (the CPC will return any I-9s to the hiring unit).

3. W-4s and State withholding forms are complete and attached, or previously submitted.

4. Verified Cost Accounting Data.

5. Other (explain): 

........................................................................................................................................

If you have any questions, please contact at .

As approving official, I certify the attached travel reimbursement and OF-288s are accurate, appropriate, and

legal for payment and meet the provisions of the Department of the Interior Pay Plan for Emergency Workers. 

Print Approving Official Name:

APPROVING OFFICIAL SIGNATURE:

Job Title:

*A unique batch number should be assigned to each payroll submitted. Please reference the applicable batch number when contacting 

the Casual Payment Center with questions.

Incidental Expenses: Pay $5 a day for all casuals listed. Starting Date Ending Date . 

*** Provide only if no other travel costs are incurred ***
Batch Number: *EFT OR EFT

Waiver

Name of Casual

OF-288W-4EFT*EFT Waiver*FEHBOther

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DOI CASUAL HIRE TRAVEL PROCESS

CASUAL HIRE TRAVEL EXPENSE REIMBURSEMENT CLAIMED ON THE

INCIDENT TIME REPORT (OF-288)

All temporary duty travel for casual hired employees will be governed and processed in accordance 

with the General Service Administration (GSA) Federal Travel Regulations, DOI TDY Travel Policy, and the 

Temporary Duty Travel policies of the Indian Affairs Manual:

• Federal Travel Regulations (FTR) Chapters 300–General and 301–Temporary Duty (TDY)

Travel Allowances

• DOI Decision Memorandum for the Principal Deputy Assistant Secretary – Policy, 

Management and Budget (Waiver of E-Gove Travel Services [ETS] Requirements for Casual 

Hires

• Department of Interior Office of Wildland Fire (OWF) Travel Policy Memorandum 2016-04

Non-compliance with these regulations may result in a bill for collection issued to the casual

employees.

TRAVEL REIMBURSEMENT METHODS

There are two methods for casual employees to claim allowed travel expenses; on the Incident

Time Report, also called the OF-288, or the official electronic travel vouchering system.

TRAVEL REIMBURSEMENT PROCESS

Under the terms of OWF travel waiver, hiring units should process casual travel for incident

assignments utilizing the OF-288 whenever possible (this process does not apply for travel 

associated with casuals attending training or Rx assignments). Only the following items should

be reimbursed utilizing the OF-288:

• Privately Owned Vehicle (POV) Mileage

• Per Diem - M&IE, no receipts (limit 15 meals per incident)

The official electronic travel system (ETS) must be used for casual reimbursement under the

followingcircumstances:

• Travel related lodging, baggage fees, parking, tolls, and laundry expenses

• Rental Car rented by Casual Employee

• All training and non-emergency related travel that can be planned and authorized in advance

• Any unusual or complex travel reimbursement claims (privately owned airplane mileage,

RV rental space fees, extended duration, etc.)

A copy of the employee’s OF-288 is required to be uploaded, with other documents and receipts,

into the official electronic travel system for the period of travel.

Casual Employee Pay on the OF-288 will not be held for more than five business days at DOI 

Casual Pay Support Desk for pending travel reimbursement issues. When travel issues cannot be
2

resolved after initial contact, and one follow up by CPC; travel claims will be removed from the 

OF-288 and payment for work time will be processed. Home/hiring units will be notified in 

writing and travel will need to be claimed through one of the two systems when resolved by

hiring unit.

When a casual has reimbursable expenses that are not approved for reimbursement on the OF-288

the entire travel reimbursement should be processed through the electronic travel system. Travel

reimbursement cannot be split between the two systems; one or the other must be utilized for the

complete trip orassignment.

RATES OF REIMBURSEMENT

Rates of reimbursement for per diem lodging and meals and incidental expenses (M&IE)] will

correspond to the current rates posted on the GSA website at www.gsa.gov/perdiem. The 

location of the incident determines the maximum per diem reimbursement rate. Use the Standard 

Rate for Incident Camps located in unlisted counties. First and last day reimbursements will be

made at 75% ofthe applicable M&IE rate and must be adjusted for meals furnished to the casual 

by the Government. The following table shows the calculation for 75% of the per diem rates, as 

well as examples of calculating first and last day when meals are provided.

2022 M&IE Breakdown - STANDARD CONUS RATES

M&IE Total $59.00 $64.00 $69.00 $74.00 $79.00

Breakfast $13.00 $14.00 $16.00 $17.00 $18.00

Lunch $15.00 $16.00 $17.00 $18.00 $20.00

Dinner $26.00 $29.00 $31.00 $34.00 $36.00

Incidentals $5.00 $5.00 $5.00 $5.00 $5.00

75% M&IE Total (first and last day) $44.25 $48.00 $51.75 $55.50 $59.25

 EXAMPLES

First Day - less dinner provided

M&IE Total $44.25 $48.00 $51.75 $55.50 $59.25

Dinner $26.00 $29.00 $31.00 $34.00 $36.00

REVISED PER DIEM $18.25 $19.00 $20.75 $21.50 $23.25

Last Day - less breakfast provided

M&IE Total $44.25 $48.00 $51.75 $55.50 $59.25

Breakfast $13.00 $14.00 $16.00 $17.00 $18.00

REVISED PER DIEM $31.25 $34.00 $35.75 $38.50 $41.25

***NOTE: Revised per diem rates in tables above INCLUDE the $5.00 incidental rate.
3

• Rates of reimbursement for POV mileage must correspond to the current posted GSA rate at

https://www.gsa.gov/travel/plan-book/transportation-airfare-rates-pov-rates/privately- ownedvehicle-pov-mileage-reimbursement-rates . Mileage rates (2022) are $0.585 (subject to

change January 1

st of each year).

• Rates of reimbursement for M&IE will correspond to the current rates posted on the GSA

website at www.gsa.gov/perdiem. The location of the incident determines the maximum per 

diem reimbursement rate. First and last day reimbursements will be made at 75% of the 

applicable M&IE rate and all days must be adjusted for meals furnished to the casual by the 

Government. (See the above tables for examples calculating first and last day when meals are

provided.)

• When meals are available at government expense, such as from a caterer, they must bededucted

whether consumed or not including first and last days at 75%).

Lodging will be reimbursed at actual expenditure rates, not to exceed current GSA rates, and must

beaccompanied by a receipt.

PROCEDURES

The type of expenses incurred will determine how the employee will be reimbursed for travel

costs. If the casual has only travel expenses not requiring a receipt, it is mandatory for the 

reimbursement to be made through the OF-288. Hiring Officials/Units should process travel

reimbursement requests on the OF-288 whenever possible. Hiring Officials/Units will process 

travel expenses that require a receipt (e.g., lodging, gas, etc.) through ETS. All receipts must be 

attached to the casual’s OF-288 and submitted to and processed by the hiring unit.

PROCESSING TRAVEL WHEN NO RECEIPTS ARE REQURED

When a casual incurs only M&IE and/or POV mileage the travel will be processed by the Hiring 

Unit. Reimbursement will be included with the payment of the OF-288 for Time and Attendance 

(T&A).

Casuals away from point of hire, will document daily POV mileage on the Crew Time Report 

(CTR). Reimbursable miles driven during the assignment should be posted to appropriate calendar

dates. Return mileage will be posted to the last date of the assignment at the same number of 

miles as arrival unless the casual is reassigned to a different incident. The return mileage will be 

documented on the casual’s final CTR. If necessary, miles can be determined using Google Maps

or other mapping software.

Incidental expense allowances, separate from meals, may be posted as an individual entry for each 

calendar day, or as a lump sum combination of days. Incidental expense included in the M&IE

total allowance do not need to be posted as a separate entry.

When ETS is not used to record time and adjustments for a casual, the hard copy form OF-288

(Box 18. Commissary and Travel section), the Approving Official Batch Memo, or Travel 

Worksheet should be completed to include reimbursement for these expenses. Go to

https://www.nifc.gov/programs/casual-payment-center/cfc-forms for DOI Casual Pay forms.
4

Upon return or completion of assignment, hiring units will be responsible for processing travel 

for casuals using the electronic travel system or the OF-288. Hiring Units will continue to submit 

all original OF-288s to DOI CPC.

OF-288

1. Indicate in Box 18 Commissary and Travel - Incidentals with range of dates and POV 

mileage.

APPROVING OFFICIAL BATCH MEMO

1. Starting and ending dates for reimbursement can be completed by Approving Official on the 

Batch Memo. If there are casuals who joined the crew late or departed early, indicate those 

individuals by name and instruct to use specific dates on their OF-288s.

2. CPC will add dates and totals to each OF-288 based on the fire codes used for specific dates.

If for any reason the original OF-288 was sent to the CPC for salary payment without travel 

indications, the casual’s copy of the original timesheet will be used to prepare a supplemental for

travel reimbursement on the OF-288. On the copy write “Travel Reimbursement Only” across the

top and add travel reimbursement notations as outlined above. Hiring Unit will sign off as the Time

Officer if travel reimbursement was not included by the Hiring Unit on the original OF-288.
5

TRAVEL WORKSHEET - CREW

 

 TRAVEL WORKSHEET – SINGLE RESOURCE
2. Employee Common Identifier 3. Type of Employment (X One)

5. Name (First, Middle, Last) 6. Hiring Unit Phone Number 

9. Incident Order Number (e.g., ID-BOF-000123) 9. Incident Order Number (e.g., ID-BOF-000123) 9. Incident Order Number (e.g., ID-BOF-000123) 9. Incide

13. AD Class (e.g., B)

13. AD Class (e.g., B)

13. AD Class (e.g., B)

15. Home/Hiring Unit Accounting Code 15. Home/Hiring Unit Accounting Code 15. Home/Hiring Unit Accounting Code 15. Hom

Year 16. Total Hours Year 16. Total Hours Year 16. Total Hours Year 

For Payment Center us

18a. Month 18b. Day

20. Employee Signature

19. Remarks

NOTE: The above items are correct and proper for paymen

INCIDENT TIME REPORT 1. Hired At (e.g., ID-BOF)

4. Hiring Unit Name (e.g., Ranger 

18c. Category (e.g., commissary, meals, lodging, mileage, 

medical, etc.)

Total

Column A Column B Column C 

Same as Column Same as Column Same a

Mo Day Start Stop Hours Mo Day Start 

12. Position Code (e.g., CRWB-T)

12. Pos(e.g., CR

$ 14. AD Rate

8. Incide

11. Resource Request Number (e.g., O-33)

10. Fire Code (e.g., B2C5)

11. Resource Request Number (e.g., O-33)

10. Fire (e.g., B2

$ $

18d. Reimbursement 18e. Deduction

21. Time Officer Signature

18f. FireCode

18.Commissary and Travel

In the "hours" column, indicate "H" for hazard pay, "E" plus % for environmental differential, "T" for travel

Stop Hours Mo Day Start Stop Hours Mo 

$

8. Incident Name 8. Incident Name 10. Fire Code (e.g., B2C5)

14. AD Rate 14. AD Rate

10. Fire Code (e.g., B2C5)

8. Incident Name 

$

12. Position Code (e.g., CRWB-T)

11. Resource Request Number (e.g., O-33)

12. Position Code (e.g., CRWB-T)

Department of the Interior (Bureau of Land Management) ODepartment of Agriculture (U.S. Forest Service)

A A B 

17. T

Casual Federal Other
___________ _______________

of person entitled to payment)

NAME OF PERSON ENTITLED TO PAYMENT (last, first, middle initial)

YOUR NAME (if different from above)

YOUR ADDRESS (street, route, P.O. box, apartment number)

CITY (or APO/FPO) STATE ZIP CODE

YOUR TELEPHONE NUMBER

( ) -

SOCIAL SECURITY NUMBER OR CLAIM NUMBER (of person entitled to payment)

DIRECT DEPOSIT

OMB No. 1510-0007

Sign-Up Form Standard Form 1199A

(Rev. Feb. 2005) 

Prescribed by Treasury Department 

Treasury Department Cir. 1076

A. PERSON TO RECEIVE PAYMENT C. BANK OR CREDIT UNION INFORMATION

TYPE OF ACCOUNT CHECKING SAVINGS

9-DIGIT ROUTING NUMBER (see sample check on reverse side)

ACCOUNT NUMBER (see reverse side)

D. CERTIFICATION

B. TYPE OF PAYMENT

(check only one)

I certify that I am entitled to receive the payment identified above, and that I have 

read and understand the back of this form. In signing this form, I authorize this 

payment to be sent to the financial institution named in Part C above, to be 

deposited into the account above.

SIGNATURE DATE

SOCIAL SECURITY

SUPPLEMENTAL SECURITY INCOME 

RAILROAD RETIREMENT

CIVIL SERVICE RETIREMENT

VA COMPENSATION OR PENSION 

OTHER (specify) Casual Pay

FOR JOINT ACCOUNT HOLDERS

I certify that I have read the SPECIAL NOTICE TO JOINT ACCOUNT 

HOLDERS on the back of this form.

SIGNATURE DATE

DIRECTIONS

Please refer to the information on the reverse side before completing this form.

You must complete a separate form for each type of federal payment (social security, supplemental 

security income, veterans' benefits, etc.).

You are responsible for keeping the paying agency informed of any name or address changes. Return

the completed form to the federal agency from which you will be receiving Direct Deposit payments.

National Interagency Fire Center 

Casual Payment Center 

A Service First Organization 

CASUAL PAYMENT CENTER MS 270

3833 S DEVELOPMENT AVE BOISE, ID 83705-5354

PHONE: 877-471-2262 FAX 208-433-6405
PLEASE READ THIS CAREFULLY

PRIVACY ACT NOTICE

Your social security number and the other information requested will allow the federal government to make 

payments to you by Direct Deposit. This collection of information is authorized by Title 31 of the United States 

Code, Section 3332(g). Also, Executive Order 9397, November 22, 1943, authorizes the use of your social

security number. Your social security number is requested to ensure the accurate identification and retention

of records pertaining to you and to distinguish you from other recipients of federal payments.

This information will be disclosed to the Department of the Treasury or another disbursing official to process 

federal payments to you by Direct Deposit. This information may also be disclosed to a court, congressional 

committee or another government agency as authorized or required by federal law and to your financial

institution to verify receipt of your federal payments. Although providing the requested information is

voluntary, your Direct Deposit payment may be delayed or Treasury may be unable to send it if you fail to 

provide the information.

SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS

If your account is a joint account and receives Direct Deposit benefit payments, you must inform the federal 

agency and the financial institution of the death of a beneficiary. Payments sent by Direct Deposit after the 

date of death or ineligibility of a beneficiary (except for salary payments) must be returned to the federal

agency. The federal agency will then determine if the survivor is eligible for benefits.

CANCELLATION

Your payment will be sent by Direct Deposit until the federal agency that issues the payments is notified to 

cancel,

suchasinthecaseofdeathorlegalincapacityofthepaymentrecipient.

Your financial institution may cancel your Direct Deposit authorization. Your financial institution is required to

give you written notice 30 days in advance of the cancellation date. If this occurs, you must notify the federal 

agency that the Direct Deposit authorization was cancelled.

BURDEN ESTIMATE STATEMENT

The estimated average time (burden hours) associated with filling out this paperwork is 10 minutes per respondent or recordkeeper, 

depending on individual circumstances. Comments concerning the accuracy of this time estimate and suggestions for reducing the 

burden should be directed to the Financial Management Service, Administrative Programs Division, Records and Information

Management Program, 3700 East-West Highway, Room 135, Hyattsville, MD 20782. THIS ADDRESS SHOULD ONLY BE USED

FOR COMMENTS AND/OR SUGGESTIONS CONCERNING THE AMOUNT OF TIME SPENT COLLECTING THE DATA. DO NOT 

SEND THE COMPLETED PAPERWORK TO THE ADDRESS ABOVE FOR PROCESSING.
	
		

	 

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USCIS

Form I-9

OMB No. 1615-0047

Expires 10/31/2022

Employment Eligibility Verification

Department of Homeland Security

U.S. Citizenship and Immigration Services

Form I-9 10/21/2019 Page 1 of 3

Employee's E-mail Address

- -

Date of Birth (mm/dd/yyyy) U.S. Social Security Number Employee's Telephone Number

Address (Street Number and Name) Apt. Number City or Town State ZIP Code

Last Name (Family Name) First Name (Given Name) Middle Initial Other Last Names Used (if any)

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later 

than the first day of employment, but not before accepting a job offer.)

Signature of Employee Today's Date (mm/dd/yyyy)

► START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, 

during completion of this form. Employers are liable for errors in the completion of this form.

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an 

employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the 

documentation presented has a future expiration date may also constitute illegal discrimination.

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in 

connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):

1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident (Alien Registration Number/USCIS Number):

4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): 

Some aliens may write "N/A" in the expiration date field. (See instructions)

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:

An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number:

OR

2. Form I-94 Admission Number:

OR

3. Foreign Passport Number:

Country of Issuance:

QR Code - Section 1 

Do Not Write In This Space

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my

knowledge the information is true and correct.

Signature of Preparer or Translator Today's Date (mm/dd/yyyy)

Last Name (Family Name) First Name (Given Name)

Address (Street Number and Name) City or Town State ZIP Code

 Employer Completes Next Page 

Preparer and/or Translator Certification (check one):

I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1.

(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)
USCIS

Form I-9

OMB No. 1615-0047

Expires 10/31/2022

Employment Eligibility Verification

Department of Homeland Security

U.S. Citizenship and Immigration Services

Form I-9 10/21/2019 Page 2 of 3

Section 2. Employer or Authorized Representative Review and Verification

(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You 

must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists 

of Acceptable Documents.")

Employee Info from Section 1

Last Name (Family Name) First Name (Given Name) M.I. Citizenship/Immigration Status

List A OR List B AND List C

Identity and Employment Authorization Identity Employment Authorization

Document Title Document Title Document Title

Issuing Authority Issuing Authority Issuing Authority

Document Number Document Number Document Number

Expiration Date (if any) (mm/dd/yyyy) Expiration Date (if any) (mm/dd/yyyy) Expiration Date (if any) (mm/dd/yyyy)

Document Title

Additional Information QR Code - Sections 2 & 3

Do Not Write In This Space Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee,

(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the 

employee is authorized to work in the United States.

The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions)

Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Title of Employer or Authorized Representative

Last Name of Employer or Authorized Representative First Name of Employer or Authorized Representative Employer's Business or Organization Name

Employer's Business or Organization Address (Street Number and Name) City or Town State ZIP Code

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)

A. New Name (if applicable) B. Date of Rehire (if applicable)

Last Name (Family Name) First Name (Given Name) Middle Initial Date (mm/dd/yyyy)

C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes 

continuing employment authorization in the space provided below.

Document Title Document Number Expiration Date (if any) (mm/dd/yyyy)

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if 

the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Name of Employer or Authorized Representative
Form I-9 10/21/2019 Page 3 of 3

LISTS OF ACCEPTABLE DOCUMENTS

All documents must be UNEXPIRED

Employees may present one selection from List A

or a combination of one selection from List B and one selection from List C.

LIST A

Documents that Establish 

Both Identity and 

Employment Authorization OR

LIST B LIST C

Documents that Establish Documents that Establish 

Identity Employment Authorization

AND

1. U.S. Passport or U.S. Passport Card 1. Driver's license or ID card issued by a 

State or outlying possession of the 

United States provided it contains a 

photograph or information such as 

name, date of birth, gender, height, eye 

color, and address

1. A Social Security Account Number 

card, unless the card includes one of 

the following restrictions:

(1) NOT VALID FOR EMPLOYMENT

(2) VALID FOR WORK ONLY WITH 

INS AUTHORIZATION

(3) VALID FOR WORK ONLY WITH 

DHS AUTHORIZATION

2. Permanent Resident Card or Alien 

Registration Receipt Card (Form I-551)

3. Foreign passport that contains a 

temporary I-551 stamp or temporary 

I-551 printed notation on a machinereadable immigrant visa

2. ID card issued by federal, state or local 

government agencies or entities, 

provided it contains a photograph or 

information such as name, date of birth, 

gender, height, eye color, and address

4. Employment Authorization Document 

that contains a photograph (Form

I-766)

2. Certification of report of birth issued 

by the Department of State (Forms 

DS-1350, FS-545, FS-240)

3. School ID card with a photograph 5. For a nonimmigrant alien authorized 

to work for a specific employer 

because of his or her status:

a. Foreign passport; and

b. Form I-94 or Form I-94A that has 

the following:

(1) The same name as the passport; 

and

(2) An endorsement of the alien's 

nonimmigrant status as long as 

that period of endorsement has 

not yet expired and the 

proposed employment is not in 

conflict with any restrictions or 

limitations identified on the form.

3. Original or certified copy of birth 

certificate issued by a State, 

county, municipal authority, or 

territory of the United States 

bearing an official seal

4. Voter's registration card

5. U.S. Military card or draft record

6. Military dependent's ID card

7. U.S. Coast Guard Merchant Mariner 4. Native American tribal document

Card 5. U.S. Citizen ID Card (Form I-197)

8. Native American tribal document 6. Identification Card for Use of 

Resident Citizen in the United 

States (Form I-179)

9. Driver's license issued by a Canadian 

government authority

For persons under age 18 who are 

unable to present a document 

listed above:

7. Employment authorization 

document issued by the 

Department of Homeland Security

6. Passport from the Federated States 

of Micronesia (FSM) or the Republic 

of the Marshall Islands (RMI) with 

Form I-94 or Form I-94A indicating 

nonimmigrant admission under the

Compact of Free Association Between 

the United States and the FSM or RMI

10. School record or report card

11. Clinic, doctor, or hospital record

12. Day-care or nursery school record

Examples of many of these documents appear in the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.
Form W-4

Department of the Treasury 

Internal Revenue Service 

Employee’s Withholding Certificate

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. 

Give Form W-4 to your employer. 

Your withholding is subject to review by the IRS.

OMB No. 1545-0074

2023

Step 1: 

Enter 

Personal 

Information

(a) First name and middle initial Last name

Address 

City or town, state, and ZIP code

(b) Social security number

Does your name match the 

name on your social security 

card? If not, to ensure you get 

credit for your earnings, 

contact SSA at 800-772-1213 

or go to www.ssa.gov.

(c) Single or Married filing separately

Married filing jointly or Qualifying surviving spouse

Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can 

claim exemption from withholding, other details, and privacy.

Step 2: 

Multiple Jobs 

or Spouse 

Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse 

also works. The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following.

(a) Reserved for future use.

(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or

(c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This 

option is generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the 

higher paying job. Otherwise, (b) is more accurate ..................

TIP: If you have self-employment income, see page 2.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will 

be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

Step 3: 

Claim 

Dependent 

and Other 

Credits 

If your total income will be $200,000 or less ($400,000 or less if married filing jointly): 

Multiply the number of qualifying children under age 17 by $2,000 $

Multiply the number of other dependents by $500 . . . . . $

Add the amounts above for qualifying children and other dependents. You may add to 

this the amount of any other credits. Enter the total here .......... 3 $

Step 4 

(optional): 

Other 

Adjustments

(a) Other income (not from jobs). If you want tax withheld for other income you 

expect this year that won’t have withholding, enter the amount of other income here. 

This may include interest, dividends, and retirement income ........ 4(a) $

(b) Deductions. If you expect to claim deductions other than the standard deduction and 

want to reduce your withholding, use the Deductions Worksheet on page 3 and enter 

the result here . . . . . . . . . . . . . . . . . . . . . . . 4(b) $

(c) Extra withholding. Enter any additional tax you want withheld each pay period .. 4(c) $

Step 5: 

Sign 

Here

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

Employee’s signature (This form is not valid unless you sign it.) Date 

Employers 

Only

Employer’s name and address First date of 

employment

Employer identification 

number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 10220Q Form W-4 (2023)
Form W-4 (2023) Page 2

General Instructions

Section references are to the Internal Revenue Code. 

Future Developments

For the latest information about developments related to 

Form W-4, such as legislation enacted after it was published, 

go to www.irs.gov/FormW4.

Purpose of Form

Complete Form W-4 so that your employer can withhold the 

correct federal income tax from your pay. If too little is 

withheld, you will generally owe tax when you file your tax 

return and may owe a penalty. If too much is withheld, you 

will generally be due a refund. Complete a new Form W-4 

when changes to your personal or financial situation would 

change the entries on the form. For more information on 

withholding and when you must furnish a new Form W-4, 

see Pub. 505, Tax Withholding and Estimated Tax. 

Exemption from withholding. You may claim exemption 

from withholding for 2023 if you meet both of the following 

conditions: you had no federal income tax liability in 2022 

and you expect to have no federal income tax liability in 

2023. You had no federal income tax liability in 2022 if (1) 

your total tax on line 24 on your 2022 Form 1040 or 1040-SR 

is zero (or less than the sum of lines 27, 28, and 29), or (2) 

you were not required to file a return because your income 

was below the filing threshold for your correct filing status. If 

you claim exemption, you will have no income tax withheld 

from your paycheck and may owe taxes and penalties when 

you file your 2023 tax return. To claim exemption from 

withholding, certify that you meet both of the conditions 

above by writing “Exempt” on Form W-4 in the space below 

Step 4(c). Then, complete Steps 1(a), 1(b), and 5. Do not 

complete any other steps. You will need to submit a new 

Form W-4 by February 15, 2024.

Your privacy. If you have concerns with Step 2(c), you may 

choose Step 2(b); if you have concerns with Step 4(a), you 

may enter an additional amount you want withheld per pay 

period in Step 4(c). 

Self-employment. Generally, you will owe both income and 

self-employment taxes on any self-employment income you 

receive separate from the wages you receive as an 

employee. If you want to pay income and self-employment 

taxes through withholding from your wages, you should 

enter the self-employment income on Step 4(a). Then 

compute your self-employment tax, divide that tax by the 

number of pay periods remaining in the year, and include 

that resulting amount per pay period on Step 4(c). You can 

also add half of the annual amount of self-employment tax to 

Step 4(b) as a deduction. To calculate self-employment tax, 

you generally multiply the self-employment income by 

14.13% (this rate is a quick way to figure your selfemployment tax and equals the sum of the 12.4% social 

security tax and the 2.9% Medicare tax multiplied by 

0.9235). See Pub. 505 for more information, especially if the 

sum of self-employment income multiplied by 0.9235 and 

wages exceeds $160,200 for a given individual.

Nonresident alien. If you’re a nonresident alien, see Notice 

1392, Supplemental Form W-4 Instructions for Nonresident 

Aliens, before completing this form.

Specific Instructions

Step 1(c). Check your anticipated filing status. This will 

determine the standard deduction and tax rates used to 

compute your withholding.

Step 2. Use this step if you (1) have more than one job at the 

same time, or (2) are married filing jointly and you and your 

spouse both work. 

If you (and your spouse) have a total of only two jobs, you 

may check the box in option (c). The box must also be 

checked on the Form W-4 for the other job. If the box is 

checked, the standard deduction and tax brackets will be 

cut in half for each job to calculate withholding. This option 

is roughly accurate for jobs with similar pay; otherwise, more 

tax than necessary may be withheld, and this extra amount 

will be larger the greater the difference in pay is between the 

two jobs.

F! CAUTION

Multiple jobs. Complete Steps 3 through 4(b) on only 

one Form W-4. Withholding will be most accurate if 

you do this on the Form W-4 for the highest paying job.

Step 3. This step provides instructions for determining the 

amount of the child tax credit and the credit for other 

dependents that you may be able to claim when you file your 

tax return. To qualify for the child tax credit, the child must 

be under age 17 as of December 31, must be your 

dependent who generally lives with you for more than half 

the year, and must have the required social security number. 

You may be able to claim a credit for other dependents for 

whom a child tax credit can’t be claimed, such as an older 

child or a qualifying relative. For additional eligibility 

requirements for these credits, see Pub. 501, Dependents, 

Standard Deduction, and Filing Information. You can also 

include other tax credits for which you are eligible in this 

step, such as the foreign tax credit and the education tax 

credits. To do so, add an estimate of the amount for the year 

to your credits for dependents and enter the total amount in 

Step 3. Including these credits will increase your paycheck 

and reduce the amount of any refund you may receive when 

you file your tax return. 

Step 4 (optional).

Step 4(a). Enter in this step the total of your other 

estimated income for the year, if any. You shouldn’t include 

income from any jobs or self-employment. If you complete 

Step 4(a), you likely won’t have to make estimated tax 

payments for that income. If you prefer to pay estimated tax 

rather than having tax on other income withheld from your 

paycheck, see Form 1040-ES, Estimated Tax for Individuals.

Step 4(b). Enter in this step the amount from the 

Deductions Worksheet, line 5, if you expect to claim 

deductions other than the basic standard deduction on your 

2023 tax return and want to reduce your withholding to 

account for these deductions. This includes both itemized 

deductions and other deductions such as for student loan 

interest and IRAs.

Step 4(c). Enter in this step any additional tax you want 

withheld from your pay each pay period, including any 

amounts from the Multiple Jobs Worksheet, line 4. Entering 

an amount here will reduce your paycheck and will either 

increase your refund or reduce any amount of tax that you 

owe.
Form W-4 (2023) Page 3

Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only 

ONE Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest

paying job. To be accurate, submit a new Form W-4 for all other jobs if you have not updated your withholding since 2019.

Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional 

tables.

1 Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one

job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the

“Lower Paying Job” column, find the value at the intersection of the two household salaries and enter 

that value on line 1. Then, skip to line 3 ..................... 1 $

2 Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and 

2c below. Otherwise, skip to line 3.

a Find the amount from the appropriate table on page 4 using the annual wages from the highest 

paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job

in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries 

and enter that value on line 2a ....................... 2a $

b Add the annual wages of the two highest paying jobs from line 2a together and use the total as the 

wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower 

Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount 

on line 2b ............................. 2b $

c Add the amounts from lines 2a and 2b and enter the result on line 2c .......... 2c $

3 Enter the number of pay periods per year for the highest paying job. For example, if that job pays

weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. ..... 3

4 Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this

amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional

amount you want withheld) ......................... 4 $

Step 4(b)—Deductions Worksheet (Keep for your records.)

1 Enter an estimate of your 2023 itemized deductions (from Schedule A (Form 1040)). Such deductions

may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to 

$10,000), and medical expenses in excess of 7.5% of your income ............ 1 $

2 Enter: { • $27,700 if you’re married filing jointly or a qualifying surviving spouse• $20,800 if you’re head of household

• $13,850 if you’re single or married filing separately } ..... 2 $

3 If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater 

than line 1, enter “-0-” .......................... 3 $

4 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other 

adjustments (from Part II of Schedule 1 (Form 1040)). See Pub. 505 for more information .... 4 $

5 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4 ........... 5 $

Privacy Act and Paperwork Reduction Act Notice. We ask for the information 

on this form to carry out the Internal Revenue laws of the United States. Internal 

Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to 

provide this information; your employer uses it to determine your federal income 

tax withholding. Failure to provide a properly completed form will result in your 

being treated as a single person with no other entries on the form; providing 

fraudulent information may subject you to penalties. Routine uses of this 

information include giving it to the Department of Justice for civil and criminal 

litigation; to cities, states, the District of Columbia, and U.S. commonwealths and 

territories for use in administering their tax laws; and to the Department of Health 

and Human Services for use in the National Directory of New Hires. We may also 

disclose this information to other countries under a tax treaty, to federal and state 

agencies to enforce federal nontax criminal laws, or to federal law enforcement 

and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is 

subject to the Paperwork Reduction Act unless the form displays a valid OMB 

control number. Books or records relating to a form or its instructions must be 

retained as long as their contents may become material in the administration of 

any Internal Revenue law. Generally, tax returns and return information are 

confidential, as required by Code section 6103. 

The average time and expenses required to complete and file this form will vary 

depending on individual circumstances. For estimated averages, see the 

instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear 

from you. See the instructions for your income tax return.
Form W-4 (2023) Page 4

Married Filing Jointly or Qualifying Surviving Spouse

Higher Paying Job 

Annual Taxable 

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

 $0 - 

9,999

$10,000 - 

19,999

$20,000 - 

29,999

$30,000 - 

39,999

$40,000 - 

49,999

$50,000 - 

59,999

$60,000 - 

69,999

$70,000 - 

79,999

$80,000 - 

89,999

$90,000 - 

99,999

$100,000 - 

109,999

$110,000 - 

120,000

$0 - 9,999 $0 $0 $850 $850 $1,000 $1,020 $1,020 $1,020 $1,020 $1,020 $1,020 $1,870

$10,000 - 19,999 0 930 1,850 2,000 2,200 2,220 2,220 2,220 2,220 2,220 3,200 4,070

$20,000 - 29,999 850 1,850 2,920 3,120 3,320 3,340 3,340 3,340 3,340 4,320 5,320 6,190

$30,000 - 39,999 850 2,000 3,120 3,320 3,520 3,540 3,540 3,540 4,520 5,520 6,520 7,390

$40,000 - 49,999 1,000 2,200 3,320 3,520 3,720 3,740 3,740 4,720 5,720 6,720 7,720 8,590

$50,000 - 59,999 1,020 2,220 3,340 3,540 3,740 3,760 4,750 5,750 6,750 7,750 8,750 9,610

$60,000 - 69,999 1,020 2,220 3,340 3,540 3,740 4,750 5,750 6,750 7,750 8,750 9,750 10,610

$70,000 - 79,999 1,020 2,220 3,340 3,540 4,720 5,750 6,750 7,750 8,750 9,750 10,750 11,610

$80,000 - 99,999 1,020 2,220 4,170 5,370 6,570 7,600 8,600 9,600 10,600 11,600 12,600 13,460

$100,000 - 149,999 1,870 4,070 6,190 7,390 8,590 9,610 10,610 11,660 12,860 14,060 15,260 16,330

$150,000 - 239,999 2,040 4,440 6,760 8,160 9,560 10,780 11,980 13,180 14,380 15,580 16,780 17,850

$240,000 - 259,999 2,040 4,440 6,760 8,160 9,560 10,780 11,980 13,180 14,380 15,580 16,780 17,850

$260,000 - 279,999 2,040 4,440 6,760 8,160 9,560 10,780 11,980 13,180 14,380 15,580 16,780 18,140

$280,000 - 299,999 2,040 4,440 6,760 8,160 9,560 10,780 11,980 13,180 14,380 15,870 17,870 19,740

$300,000 - 319,999 2,040 4,440 6,760 8,160 9,560 10,780 11,980 13,470 15,470 17,470 19,470 21,340

$320,000 - 364,999 2,040 4,440 6,760 8,550 10,750 12,770 14,770 16,770 18,770 20,770 22,770 24,640

$365,000 - 524,999 2,970 6,470 9,890 12,390 14,890 17,220 19,520 21,820 24,120 26,420 28,720 30,880

$525,000 and over 3,140 6,840 10,460 13,160 15,860 18,390 20,890 23,390 25,890 28,390 30,890 33,250

Single or Married Filing Separately

Higher Paying Job 

Annual Taxable 

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

 $0 - 

9,999

$10,000 - 

19,999

$20,000 - 

29,999

$30,000 - 

39,999

$40,000 - 

49,999

$50,000 - 

59,999

$60,000 - 

69,999

$70,000 - 

79,999

$80,000 - 

89,999

$90,000 - 

99,999

$100,000 - 

109,999

$110,000 - 

120,000

$0 - 9,999 $310 $890 $1,020 $1,020 $1,020 $1,860 $1,870 $1,870 $1,870 $1,870 $2,030 $2,040

$10,000 - 19,999 890 1,630 1,750 1,750 2,600 3,600 3,600 3,600 3,600 3,760 3,960 3,970

$20,000 - 29,999 1,020 1,750 1,880 2,720 3,720 4,720 4,730 4,730 4,890 5,090 5,290 5,300

$30,000 - 39,999 1,020 1,750 2,720 3,720 4,720 5,720 5,730 5,890 6,090 6,290 6,490 6,500

$40,000 - 59,999 1,710 3,450 4,570 5,570 6,570 7,700 7,910 8,110 8,310 8,510 8,710 8,720

$60,000 - 79,999 1,870 3,600 4,730 5,860 7,060 8,260 8,460 8,660 8,860 9,060 9,260 9,280

$80,000 - 99,999 1,870 3,730 5,060 6,260 7,460 8,660 8,860 9,060 9,260 9,460 10,430 11,240

$100,000 - 124,999 2,040 3,970 5,300 6,500 7,700 8,900 9,110 9,610 10,610 11,610 12,610 13,430

$125,000 - 149,999 2,040 3,970 5,300 6,500 7,700 9,610 10,610 11,610 12,610 13,610 14,900 16,020

$150,000 - 174,999 2,040 3,970 5,610 7,610 9,610 11,610 12,610 13,750 15,050 16,350 17,650 18,770

$175,000 - 199,999 2,720 5,450 7,580 9,580 11,580 13,870 15,180 16,480 17,780 19,080 20,380 21,490

$200,000 - 249,999 2,900 5,930 8,360 10,660 12,960 15,260 16,570 17,870 19,170 20,470 21,770 22,880

$250,000 - 399,999 2,970 6,010 8,440 10,740 13,040 15,340 16,640 17,940 19,240 20,540 21,840 22,960

$400,000 - 449,999 2,970 6,010 8,440 10,740 13,040 15,340 16,640 17,940 19,240 20,540 21,840 22,960

$450,000 and over 3,140 6,380 9,010 11,510 14,010 16,510 18,010 19,510 21,010 22,510 24,010 25,330

Head of Household

Higher Paying Job 

Annual Taxable 

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

 $0 - 

9,999

$10,000 - 

19,999

$20,000 - 

29,999

$30,000 - 

39,999

$40,000 - 

49,999

$50,000 - 

59,999

$60,000 - 

69,999

$70,000 - 

79,999

$80,000 - 

89,999

$90,000 - 

99,999

$100,000 - 

109,999

$110,000 - 

120,000

$0 - 9,999 $0 $620 $860 $1,020 $1,020 $1,020 $1,020 $1,650 $1,870 $1,870 $1,890 $2,040

$10,000 - 19,999 620 1,630 2,060 2,220 2,220 2,220 2,850 3,850 4,070 4,090 4,290 4,440

$20,000 - 29,999 860 2,060 2,490 2,650 2,650 3,280 4,280 5,280 5,520 5,720 5,920 6,070

$30,000 - 39,999 1,020 2,220 2,650 2,810 3,440 4,440 5,440 6,460 6,880 7,080 7,280 7,430

$40,000 - 59,999 1,020 2,220 3,130 4,290 5,290 6,290 7,480 8,680 9,100 9,300 9,500 9,650

$60,000 - 79,999 1,500 3,700 5,130 6,290 7,480 8,680 9,880 11,080 11,500 11,700 11,900 12,050

$80,000 - 99,999 1,870 4,070 5,690 7,050 8,250 9,450 10,650 11,850 12,260 12,460 12,870 13,820

$100,000 - 124,999 2,040 4,440 6,070 7,430 8,630 9,830 11,030 12,230 13,190 14,190 15,190 16,150

$125,000 - 149,999 2,040 4,440 6,070 7,430 8,630 9,980 11,980 13,980 15,190 16,190 17,270 18,530

$150,000 - 174,999 2,040 4,440 6,070 7,980 9,980 11,980 13,980 15,980 17,420 18,720 20,020 21,280

$175,000 - 199,999 2,190 5,390 7,820 9,980 11,980 14,060 16,360 18,660 20,170 21,470 22,770 24,030

$200,000 - 249,999 2,720 6,190 8,920 11,380 13,680 15,980 18,280 20,580 22,090 23,390 24,690 25,950

$250,000 - 449,999 2,970 6,470 9,200 11,660 13,960 16,260 18,560 20,860 22,380 23,680 24,980 26,230

$450,000 and over 3,140 6,840 9,770 12,430 14,930 17,430 19,930 22,430 24,150 25,650 27,150 28,600
Other (such as bus, gov’t vehicle, EERA): 

 Casual or 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NWCG Single Resource Casual Hire Information 

CASUAL INFORMATION 

Casual’s Name (print): Phone #: Start Date: 

Point-of-Hire: City: State: ECI #: 

HIRING UNIT INFORMATION 

Office Name: Hiring Location (example: ID-BOF): 

Hiring Official’s Name (print): Phone #: 

POSITION INFORMATION 

Job Title: AD Class: _____ AD Rate: $_____ Request #: FireCode:_____ 

Incident Order # (example: ID-BOF-000423): Incident Location (City/State): 

Hiring of emergency personnel may be made according to the provisions of the current Administratively Determined Pay Plan 

for Emergency Workers when any of the following conditions exist. Reference the Pay Plan for specific determinations. 

 1. To fight an ongoing fire.

 2. Unusually dry period or fire danger is high to extreme.

 3. Provide support to ongoing incidents to include post-incident administration (dispatch, warehouse/cache, administrative support)

normally not to exceed 90 calendar days.

 4. Place firefighters on standby for expected dispatch.

 5. Temporarily replace members of fire suppression crews or fire management personnel who have been mobilized to incidents.

 6. Attend emergency incident training. Course Title:

 7. Instruct emergency incident training when all other methods of hiring and contracting instructors have been exhausted.

 8. Cope with floods, storms, or any other all-hazard emergency.

 9. Carry out emergency stabilization work when there is an immediate danger of loss of life or property.

 10. Following a natural emergency, develop plans, and manage emergency stabilization efforts.

 11. Meet FEMA mission assignments.

 12. Provide public awareness for an emerging or projected incident, event, or situation.

 13. For hazardous fuel reduction projects (excludes mechanical or chemical treatments).

TRAVEL/TRANSPORTATION/SUBSISTENCE 

Travel for casual hires will be processed in accordance with Federal Travel Regulations, AD Pay Plan, and agency policy. 

Casual is entitled to transportation to and from the incident:  No  Yes 

Transportation method: 

 Airline

 POV Mileage Reimbursement Authorized:  POV – TDY (higher rate) or  POV – Agency Vehicle Available (lower rate)

 Rental Vehicle (must be on resource order): Rental provided by: Government



Subsistence: 

If Casual Is Subsisted by the Government, Those Expenses Shall Not Be Claimed on a Travel Voucher. 

HIRING DOCUMENTS 

Completed by: 

Agency 

 I-9, Employment Eligibility Verification (valid for 3 years)

 State/federal government-issued photo ID verified and in casual’s possession (required for all positions).

 Incident qualification card (if required for position) verified and in casual’s possession.

 State-required certification verified, if required for position (e.g., CDL, driver’s license, EMT certificate).

Casual  Federal W-4  State tax (if applicable)  Incident Behavior, PMS 935-1  Direct Deposit  Conditional Offer of FEHB

I understand that I am being hired under the terms and conditions of the Administratively Determined Pay Plan for 

Emergency Workers. 

Casual’s signature (required) Date 

Hiring official’s signature (required) Date 

Distribution: Follow agency hiring procedures. 

NON-DISCRIMINATION POLICY STATEMENT: The U.S. Government prohibits discrimination in all its programs and activities on the basis of 

race, color, national origin, age, disability, and, where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, 

genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (not all 

prohibited bases apply to all programs). 

PMS 934 (07/22) https://www.nwcg.gov/publications/934 
Incident Behavior

Common Responsibilities

Volunteers and Single Resource Casual Hires

Inappropriate Behavior:

It is extremely important that inappropriate behavior be recognized and dealt with promptly. 

Inappropriate behavior is all forms of harassment including sexual and racial harassment. 

Harassment in any form will not be tolerated. When you observe or hear of inappropriate behavior 

you should:

• Inform and educate subordinates of their rights and responsibilities.

o Tell the harasser to stop the offensive conduct.

• Provide support to the victim.

• Report the incident to your supervisor and the individuals’ supervisor, if the behavior continues. 

Disciplinary action may be necessary.

• Develop appropriate corrective measures.

• Document inappropriate behavior and report it to the appropriate incident manager or agency 

official.

• While working in and around private property, recognize and respect all private property.

Drugs and Alcohol:

• Non-prescription unlawful drugs and alcohol are not permitted at the incident.

• Use of medical marijuana on incidents is prohibited.

• Possession or use of these substances will result in disciplinary action.

• During off-incident rest periods, personnel are responsible for proper conduct and maintenance of 

fitness for duty. Drug or alcohol abuse resulting in unfitness for duty will result in disciplinary 

action.

• Be a positive role model. Do not be involved with drug or alcohol abuse.

• Report any observed drug or alcohol abuse to your supervisor.

I have read and I understand the above described incident behavior responsibilities:

Signature Date

PMS 935-1 (English) (rev. August 2012)
Privacy Act Statement: Information on this form is collected under the authority of the Administratively Determined (AD) Pay Plan. Information collected via this form 

is covered by the Privacy Act of 1974 and Privacy Act System of Records Notice DOI-85. The primary use of this information is to start, stop, or change entitlements 

and to process any voluntary or involuntary deductions on pay and leave issues. The information you furnish will be used to identify records properly associated with 

you, to obtain additional information to update your record, if necessary, and to determine any present or future entitlement. Disclosure may be made only to 

authorized persons according to Title 5 USC 552a and for uses described in System of Records Notices DOI-85. Submission of the information in this form is voluntary; 

however, requests will not be completed without the information needed to process the request. 

Revised 12/2016

Conditional Offer of 

Federal Employee Health Benefits Form

Check one: BIA BLM FWS NPS

NAME: SSN/ECI: 

PHONE: E-MAIL: 

...................................................................................................................................................

As an Administratively Determined Emergency Worker (AD/Casual), you will be eligible for Federal Employee 

Health Benefits (FEHB) when you work 130 hours per month for 90 consecutive days. This coverage includes a 31 

day extension of FEHB following employment termination.

More information about the FEHB program is available on the OPM website: https://www.opm.gov/healthcareinsurance/healthcare/plan-information/plans/.

As an AD/Casual, I understand that if I work 130 hours per month for 90 days, I am eligible for FEHB coverage. 

 I elect FEHB upon meeting the above eligibility criteria. 

 I decline coverage in a Federal Employee Health Benefits plan.

**I understand if at any time I choose to receive more information, I can contact the Casual Payment 

Center.

...................................................................................................................................................

By signing below, I attest I am the person named above and I have read and understand the information 

presented.

SIGNATURE: DATE: 

NATIONAL INTERAGENCY FIRE CENTER

CASUAL PAYMENT CENTER

A SERVICE FIRST ORGANIZATION

 CASUAL PAYMENT CENTER MS 270

3833 S DEVELOPMENT AVE BOISE, ID 83705-5354

PHONE: 877-471-2262 FAX: 208-433-6405
Updated 04/2022

HEALTH BENEFITS FOR DOI CASUALS HIRING UNIT GUIDANCE

To further the goal of providing affordable health insurance to Federal employees, the United 

States Office of Personnel Management (OPM) has issued a final rule modifying coverage 

under the Federal Employees Health Benefits (FEHB) Program to include certain temporary, 

seasonal, and intermittent employees who are identified as full-time employees. This 

regulation makes FEHB coverage available to eligible casuals.

Hiring Unit 

Each year the hiring official will include the FEHB Fast Facts for Casuals and require each casual to 

complete the Conditional Offer of Federal Employee Health Benefits Form at the time of hire, providing 

notification of the government’s intent to offer coverage. The casual will complete the form indicating 

whether they wish to elect or decline the offer. If the casual elects to enroll, the casual will be contacted 

when eligible, and provided with documentation to enroll. If the casual elects to decline coverage, their 

declination will be recorded, and no further contact will be made. The Conditional Offer of Federal 

Employee Health Benefits Form must be submitted to the Casual Payment Center (CPC) for processing.

Eligibility

Casuals become eligible for benefits once the casual has worked 130 hours per month for 90 

consecutive days.

The CPC will contact the casual directly by email and letter notifying them of eligibility and coverage 

options.

To enroll, the casual must complete the Health Benefits Election Form (SF-2809) and send it to the CPC. 

If the casual is eligible and fails to return the SF-2809 within 60 days of eligibility, the choice will be 

recorded as a declination of enrollment. Premiums will be based on the coverage option chosen and 

vary by plan, but generally the casual would pay approximately 30% and the agency approximately 70%.

Coverage

Initially the casual will have coverage for 28 days (2 casual pay periods) beginning on the first day of the 

following casual pay period after the CPC receives a completed Health Benefits Election Form (SF-2809).

• After 28 days, coverage ends and will automatically switch over to a free 31-day extension of 

coverage, unless:

✓ The casual has been ordered to a new assignment and has contacted the CPC to 

continue health benefits, or

✓ There is a Qualifying Life Event (QLE) that is applicable (reference Table of Permissible 

Changes in Enrollment on pages 7 through 14 of the SF-2809) and the casual elects to 

cancel coverage by completing Parts D and F the SF-2809. This form must be submitted 

to the CPC.

• When casual employment ends and during the 31-day extension, the casual may choose to 

contact their health plan and convert the insurance plan to an individual contract, or

• The casual can enroll in Temporary Continuation of Coverage (TCC) to continue the coverage 

through a FEHB plan. TCC is available to eligible former employees for up to 18 months 

following the end of employment. The casual is then responsible for the full premium amount 

(government and enrollee share) plus a 2% administrative fee.

• If the casual works any time after health benefits have been terminated within the calendar 

year, the casual can reenroll by submitting a new Health Benefits Election Form (SF-2809) to the 

CPC.
Updated 04/2022

Payment Premiums

Premiums will be based on the coverage option chosen and vary by plan, but generally the casual would 

pay approximately 30% and the agency approximately 70%. Premiums for the free 31-day extension are 

paid for by the health insurance company.

The Federal Personnel Payroll System (FPPS) will automatically calculate and deduct the premium from 

the casual’s first time and attendance payment each month. When there is not a pending payment, a bill 

for collection will be created and mailed to the casual. The casual will forward the payment to IBC for 

processing of the bill for collection.

References:

Healthcare: Plan Information - OPM.gov

https://www.nifc.gov/programs/casual-payment-center
1

FEHB FAST FACTS FOR CASUALS

What is the FEHB Program?

The Federal Employees Health Benefits Program (FEHB) provides comprehensive health 

insurance. Casual employees can choose from fee-for-service (FFS) plans, health maintenance 

organizations (HMOs), consumer-driven health plans (CDHPs) or high deductible health plans 

(HDHPs). For more information on the types of plans under FEHB, reference

www.opm.gov/insure/health/planinfo/types.asp.

What are some important things I should know?

▪ There is no waiting period or pre-existing condition limitations.

▪ Each plan contracts with doctors and hospitals (known as a provider network). Your 

doctor may participate in one or more provider networks.

▪ You will reduce your out-of-pocket costs by visiting doctors and hospitals that contract 

with your plan. Visit your plan’s website to determine which providers participate in the 

plan’s network.

How do I enroll? 

Once you have qualified for benefits by having worked 130 hours per month for 90 consecutive 

days, you must complete the Health Benefits Election Form (SF-2809). Contact the Casual 

Payment Center (CPC) for details. You will have 60 days from the date of eligibility to enroll.

Do I have to decide right away? 

If you elected to receive coverage by indicating “I elect...” on the FEHB Conditional Offer form 

during sign-up, and become eligible, the CPC will contact you and provide the Health Benefits 

Election Form (SF-2809) to enroll. You will become eligible once you have worked 130 hours

per month for 90 consecutive days. If you the employee, fails to return the SF-2809 within 60 

days of eligibility, the choice will be recorded as a declination of enrollment. 

How long do I have Health Benefits? 

Initially you will have coverage for 28 days (2 casual pay periods) beginning on the first day of 

the following pay period after the CPC receives a completed Health Benefits Election Form (SF2809). If you are still working or have been ordered to a new assignment you will be 

responsible for contacting the CPC before day 28 to continue health benefits. If you have not 

contacted the CPC before day 28, your coverage will switch over to your free 31-day extension 

of coverage. After the 31-day extension of coverage your health benefits will end. If you work 

at any time after your health benefits have terminated within the calendar year, you can 

reenroll by submitting a new Health Benefits Election Form (SF-2809) to the CPC.
2

How much do I pay? 

What you pay is based on the plan and option you choose. Premiums are shared by you and 

your Federal agency during your time of hire. Premiums vary by plan, but generally you pay 

approximately 30% and your agency pays approximately 70%.

Casuals can discuss health insurance premiums with the Casual Payment Center or find more 

information on the OPM website at https://www.opm.gov/healthcareinsurance/healthcare/plan-information/plans/.

How do I pay for coverage? 

Your share of the health plan premium will be deducted from your casual payment. When there 

is no payment in process, you will receive a bill for collection and a debt will be set up in the 

payroll system. You will be required to make payment for your portion of the premium.

Do I have to pay for my coverage with pre-tax dollars? 

Your share of the health plan premium will be paid with pre-tax dollars unless you complete a 

Federal Employees Health Benefits Program (FEHB) Premium Conversion Waiver/Election Form. 

What enrollment types are available? 

The OPM website at https://www.opm.gov/healthcare-insurance/healthcare/planinformation/plans/ will provide more detailed information based on your local coverage 

options.

What happens after my employment ends? 

When your 28 days of coverage or employment ends, you have a 31-day extension of coverage 

under the plan. During that period, you can contact your health plan company and convert the 

insurance plan to an individual contract, or you can enroll in Temporary Continuation of 

Coverage (TCC) to continue the coverage through a FEHB plan. TCC is available to eligible 

former employees for up to 18 months following the end of employment. You are then 

responsible for the full premium amount (government and enrollee share) plus a 2% 

administrative fee.

Where can I go for more details or additional information?

▪ Casual Payment Center at: 877-471-2262 – or – https://www.nifc.gov/programs/casualpayment-center/procedures

▪ OPM website at: https://www.opm.gov/healthcare-insurance/healthcare/planinformation/plans/