REQUEST FOR PERSONNEL ACTION (DISABILITY RETIREMENT).
Originator: CIA
Document date: 06/28/1973
Document type: PAPER - TEXTUAL DOCUMENT

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104-10115-10144

2022 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992

(W ben Filled In)

DATE PREPARED

REQUEST FOR PERSONNEL ACTION

1. SERIAL NUMBER

2. NAME (Last-First-Middle)

-28

FILE

June 1973

057303

GOODPASTURE, Ann kee

3. NATURE OF PERSONNEL ACTION DiSability Retirement!. EFFECTIVE DATE REQUESTED

Under CIA Retirerent &

Disability

System

06

30

73

7. FAN AND NSCA

5. CATEGORY OF EMPLOYMENT

6. FUNDS

X

¡VTOV

V TO CF

Regular

8. LEGAL AUTHORITY (Completed by Office of

Personnel)

CF TO V

CF TO CF

9. ORGANIZATIONAL DESIGNATIONS

3227-0183/0000

10. LOCATION OF OFFICIAL STATION

DDO/CI Staff

Development Complenent

Washington, D.C.

11. POSITION TITLE

Ops Officer

14. CLASSIFICATION SCHEDULE (GS. LB. exc.)

GS

15. OCCUPATIONAL SERIES

0136.01

12. POSITION NUMBER

9997

16. GRADE AND STEP

13

13. CAREER SERVICE DESIGNATION

17. SALARY OR RATE

$ 23,042

18. REMARKS

Subject has been on Extended sick leave & Disability retirement

since 14 June 1972

cc: Finance and Security

SIGNATURE OF REQUESHNE OFFICIAL

DATE SIGNED

18B. SIGNATURE OF CAREER SERVICE APPROVING OFFICER

DATE SIGNED

D. McCallum, CI Staff-6/28/73

SPACE BELOW FOR EXCLUSIVE USE OF THE OFFICE OF PERSONNEL

19. ACTION 20. EMPLOr.|

CODE

CODE

21.

OFFICE CODING

NUMERIC

ALPHABETIC

22. STATION

23. INTEGREE

CODE

CODE

26. DATE OF GRADE

MO.

DA.

YR.

но.

DATE OF LEI

DA.

YR.

28.

MO.

NTE EXPIRES

DA.

29. SPECIAL

REFERENCE

YR.

30.

-(SC

RETIREMENT DATA

CODE

31. SEPARATION

DATA CODE

32. CORRECTION/ CANCELLATIOK DATA

TYPE

MO.

DA.

YR.

33. SECURITY

REQ. NO.

34.

SEX

EOD DATA

35. VET. PREFERENCE

CODE

0-HONE

36. SERV. COMP. DATE

NO.

DA.

YR.

1-5 PT.

2-10 PT.

41.

CODE

FREVIOUS CIVILIAN GOVERKMENT SERVICE

O-NO FREYIOUS SERVICE

1-NO BREAK IN SERVICE

2-BREAK IN SERVICE (LESS THAN 3 YEARS)

3-BREAK IN SERVICE (MORE THAN 3 YEARS)

45. POSITION CONTROL CERTIFICATION

37. LONG. COMP. DATE

MO.

DA

YR.

38.

CAREER CATEGORY

CAR/RESY

CODE

PROY/ TEMP

39.

CODE

FEGLI/ HEALTH INSURANCE

O-WAIVER

HEALTH INS. CODE

fille

40. SOCIAL SECURITY NO.

42. LEAVE CAT.

CODE

43.

FORM EXECUTED CODE

1- YES

2 - N0

FEDERAL TAX DATA

NO. TAX EXEMPTIONS

44.

FORM EXECUTED

1 - YES

2- H0

STATE TAX DATA

CODE

NO. TAX STATE

EXEMP. CODE

10.0.P. APPROVAL

DATE APPROVED

FOFM

8-72 1152

USE PREVIOUS EDITION

SECRET

CLASSIFIED BY: 01-0332

EX-2

APDIR

/5D)

Do Not Reproduce

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I RESIGN EFFECTiVE

(Dase)

SECRET

(' ben Filled In)

EMPLOYEE NETICE OF RESIGNATION

FOR THE FOLLOWING REASON:

MY LAST WORKING DAY WILL BE-

DATE SIGNED

SIGNATURE Of EMPLOYEE

FORWARD COMMUNICATIONS, INCLUDING SALARY CHECKS AND BONDS, TO THE FOLLOWING ADDRESS (Number, Street, City, State, Zip Code)

INSTRUCTIONS

Items 1 thru 7

The initiating office should fill in each of the referenced items. Items 3 thru 7 and 9 thru 18 require

and

information which pertains only to the action requested, not NOT to the current status of the

Items 9 thru 18a),

employee unless specific items remain unchanged.

Item S - "Category of Employment" should show one of the following entries:

Regular

Summer

WAE

Part Time

Detail Our

Temporary

Consultant

Detail In

Military

' Temporary-Part Time

Item 9 — "Organizational Designations" should show all levels of organization pertinent to identifying the

location of the position:

E a Major Component (Director, Deputy Director, etc.)

Office, Major Staff, etc.

Foreign Field or U.S. Field (if pertinent)

Division or Staff (subordinate to first line)

Branch

Section

Unit

Items 11 and 15 - "Position Ticle" and "Occupational Series" should be the standard abbreviated title and correspond-

ing occupational series in Handbook of Official Occupational Titles and Codes for the duties

actually to be performed by the employee. If different from the title and series of the position occu-

pied as shown on the most current edition of the Position Control Register or Form 261, Staffing

Complement Change Authorization, explain under Item 18-Remarks.

Item 18b - Signature should be thät of the official authorized to approve for the Career Service to which the

employee belongs. If more than one Career Service is involved, the gaining Career Service should

approve and the other Career Service should concur in Item 18, Remarks.

ROUTING- The original only of this form will be forwarded to the Office of Personnel through the appropriate Career

Service official(s). In the case of requests specified in HB 20-800-1; which require advance approval of

or notification to the Office of Security or the Office of Finance, one copy only will be sent to the Office(s)

concerned.

SECRET

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