HTML Preview Overtime Pay Request Authorization Form page number 1.
Form 1400-64 (550)
UNITED STATES
(February 1978)
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
OVERTIME/HOLIDAY PAY REQUEST AND AUTHORIZATION
To:
NAME OF EMPLOYEE
PAY PLAN
AND
GRADE
DATES
TOTAL
HOURS
WORKED
OVER-
TIME/
HOLIDAY*
COMPENSATORY TIME
FOR OVERTIME
ELECTS**
ADMINIS-
TRATIVELY
REQUIRED***GS, WG FROM THROUGH
Justification (give description of work and reason for overtime)
Requested by
(signature)
Title Date
Organization
TitleAuthorized Officer's signature
[ ] Disapproved
[ ] Approved
Date
* Exclude meal periods
** Employee must initial
*** Authorized Officer must initial
(Instructions on reverse)
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