GSA Form 873A "Annual Attendance Record (Part-Time Employees)"

What Is GSA Form 873A?

This is a legal form that was released by the U.S. General Services Administration on December 1, 2017 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2017;
  • The latest available edition released by the U.S. General Services Administration;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;

Download a fillable version of GSA Form 873A by clicking the link below or browse more documents and templates provided by the U.S. General Services Administration.

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Download GSA Form 873A "Annual Attendance Record (Part-Time Employees)"

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TOUR OF DUTY
LEGEND:
SUGGESTED CODES:
= Last day of Month
A = Annual Leave
S = Sick Leave
E = Excused
W = Absent Without Leave
CE = Compensation Time Earned
OT = Overtime
H
= Holiday
M = Military Leave
R = Restored Leave
D = Award Leave
L = Leave Without Pay
CU = Compensation Time Used
C = Continuation of Pay for Traumatic
ANNUAL LEAVE
SICK LEAVE
LEAVE CATEGORY
PER PAY PERIOD
LEAVE
ANNUAL
SICK
1 Hour per 20 worked
1 Hour is earned for each
4
LEAVE HOURS
LEAVE HOURS
EARNED:
1 Hour per 13 worked
CARRYOVER
CARRYOVER
6
20 worked, regardless of
WORK HOURS
WORK HOURS
1 Hour per 10 worked
category.
8
HOURS
HOURS
PAY PERIOD
TOTAL
BALANCE
THIS PAY PERIOD
USED
TOTAL
BALANCE
THIS PAY PERIOD
USED
APPLIED
APPLIED
HOURS
OF HOURS
TO
BALANCE
HOURS
OF HOURS
TO
BALANCE
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
DATES
TO LEAVE
TO LEAVE
CODE
WORKED
WORKED
DATE
WORKED
WORKED
DATE
EARNED
USED
EARNED
USED
EARNED
EARNED
H
2
1/7 - 1/20
3
1/21 - 2/3
4
2/4 - 2/17
H
5
2/18 - 3/3
6
3/4 - 3/17
7
3/18 - 3/31
8
4/1 - 4/14
9
4/15 - 4/28
10
4/29 - 5/12
11
5/13 - 5/26
H
12
5/27 - 6/9
13
6/10 - 6/23
H
14
6/24 - 7/7
15
7/8 - 7/21
16
7/22 - 8/4
17
8/5 - 8/18
18
8/19 - 9/1
H
19
9/2 - 9/15
20
9/16 - 9/29
H
21
9/30 - 10/13
22
10/14 - 10/27
23
10/28 - 11/10
H
H
24
11/11 - 11/24
25
11/25 - 12/8
26
12/9 - 12/22
H
H
1
12/23 - 1/5
ADDRESS (Street, City, State, and ZIP Code)
LEAVE CATEGORY CODE
BLOCK NUMBER
SERVICE COMPUTATION DATE
LAST NAME, FIRST NAME, MIDDLE INITIAL
TELEPHONE NUMBER
ENTERED ON OR TRANSMITTAL DATE
ANNUAL ATTENDANCE RECORD (PART-TIME EMPLOYEES) - 2018
GENERAL SERVICES ADMINISTRATION
GSA 873A (REV. 12/2017)
PREVIOUS EDITION IS NOT USABLE
Sensitive, but Unclassified
(Also known as OF 873A)
TOUR OF DUTY
LEGEND:
SUGGESTED CODES:
= Last day of Month
A = Annual Leave
S = Sick Leave
E = Excused
W = Absent Without Leave
CE = Compensation Time Earned
OT = Overtime
H
= Holiday
M = Military Leave
R = Restored Leave
D = Award Leave
L = Leave Without Pay
CU = Compensation Time Used
C = Continuation of Pay for Traumatic
ANNUAL LEAVE
SICK LEAVE
LEAVE CATEGORY
PER PAY PERIOD
LEAVE
ANNUAL
SICK
1 Hour per 20 worked
1 Hour is earned for each
4
LEAVE HOURS
LEAVE HOURS
EARNED:
1 Hour per 13 worked
CARRYOVER
CARRYOVER
6
20 worked, regardless of
WORK HOURS
WORK HOURS
1 Hour per 10 worked
category.
8
HOURS
HOURS
PAY PERIOD
TOTAL
BALANCE
THIS PAY PERIOD
USED
TOTAL
BALANCE
THIS PAY PERIOD
USED
APPLIED
APPLIED
HOURS
OF HOURS
TO
BALANCE
HOURS
OF HOURS
TO
BALANCE
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
DATES
TO LEAVE
TO LEAVE
CODE
WORKED
WORKED
DATE
WORKED
WORKED
DATE
EARNED
USED
EARNED
USED
EARNED
EARNED
H
2
1/7 - 1/20
3
1/21 - 2/3
4
2/4 - 2/17
H
5
2/18 - 3/3
6
3/4 - 3/17
7
3/18 - 3/31
8
4/1 - 4/14
9
4/15 - 4/28
10
4/29 - 5/12
11
5/13 - 5/26
H
12
5/27 - 6/9
13
6/10 - 6/23
H
14
6/24 - 7/7
15
7/8 - 7/21
16
7/22 - 8/4
17
8/5 - 8/18
18
8/19 - 9/1
H
19
9/2 - 9/15
20
9/16 - 9/29
H
21
9/30 - 10/13
22
10/14 - 10/27
23
10/28 - 11/10
H
H
24
11/11 - 11/24
25
11/25 - 12/8
26
12/9 - 12/22
H
H
1
12/23 - 1/5
ADDRESS (Street, City, State, and ZIP Code)
LEAVE CATEGORY CODE
BLOCK NUMBER
SERVICE COMPUTATION DATE
LAST NAME, FIRST NAME, MIDDLE INITIAL
TELEPHONE NUMBER
ENTERED ON OR TRANSMITTAL DATE
ANNUAL ATTENDANCE RECORD (PART-TIME EMPLOYEES) - 2018
GENERAL SERVICES ADMINISTRATION
GSA 873A (REV. 12/2017)
PREVIOUS EDITION IS NOT USABLE
Sensitive, but Unclassified
(Also known as OF 873A)
This optional form is for timekeepers to use in recording daily and bi-weekly pay and leave activity. The form is a record of what SHOULD BE recorded into the official payroll system.
The bi-weekly Earnings and Leave Statement, the Supervisor's Time and Attendance Report, and the Premium Pay Report as well as other management reports reflect what IS in the
official payroll system. Those reports should agree with the data on this form. The untitled columns on this form may be used to maintain usage and balances for any leave and
premium pay categories that may apply for an individual employee. Examples: Leave categories - Shared (Donated), Restored, Award, Family Friendly (Sick or Medical), Military,
Compensatory Leave, and Credit Hours. Premium Pay hours include Environmental Differential Pay, Sunday Premium, Night Differential, as well as Overtime, and can be included.
OTHER TYPES OF LEAVE CATEGORIES
PAY PERIOD
CODE
DATES
2
1/7 - 1/20
3
1/21 - 2/3
4
2/4 - 2/17
5
2/18 - 3/3
6
3/4 - 3/17
7
3/18 - 3/31
8
4/1 - 4/14
9
4/15 - 4/28
10
4/29 - 5/12
11
5/13 - 5/26
12
5/27 - 6/9
13
6/10 - 6/23
14
6/24 - 7/7
15
7/8 - 7/21
16
7/22 - 8/4
17
8/5 - 8/18
18
8/19 - 9/1
19
9/2 - 9/15
20
9/16 - 9/29
21
9/30 - 10/13
22
10/14 - 10/27
23
10/28 - 11/10
24
11/11 - 11/24
25
11/25 - 12/8
26
12/9 - 12/22
1
12/23 - 1/5
GSA 873A (REV. 12/2017) BACK
(Also known as OF 873A)
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