Form NPD-25 "Notice of Intent to Donate Leave" - Nevada

What Is Form NPD-25?

This is a legal form that was released by the Nevada Department of Administration - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2012;
  • The latest edition provided by the Nevada Department of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form NPD-25 by clicking the link below or browse more documents and templates provided by the Nevada Department of Administration.

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Download Form NPD-25 "Notice of Intent to Donate Leave" - Nevada

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NOTICE OF INTENT TO DONATE LEAVE
Date:
Employee:
Employee ID#:
Agency:
Division:
Budget Account:
PC#:
Class Code:
Job Title:
Grade:
Hourly Rate:
I hereby declare my intent to donate leave to a catastrophic leave account as follows:
_______ hours to my agency's general catastrophic leave bank
_______ hours to the catastrophic leave account for use by:
Recipient’s name: ____________________________________________ Agency: _________________________
Leave is to be deducted from my account as follows:
_______ hours of annual leave
_______ hours of sick leave
_______ hours of special sick leave
I agree to allow my identity as a donor shared with the recipient upon the recipient’s request.
I certify that I have sufficient leave balances to make this election and that I will not by this authorization exceed the 120-hour
maximum leave donation in this calendar year.
__________________________________________________
__________________________________________________
Donor's Signature
Date
Appointing Authority
Date
Distribution: Donor's Appointing Authority, Recipient's Appointing Authority
************************************************************************************************************************************
REQUEST TO TRANSFER LEAVE
Pursuant to the above notice from ______________________________________, it is requested that _______ hours of leave be
transferred to the catastrophic leave account for:
Date:
Employee:
Employee ID#:
Agency:
Division:
Budget Account:
PC#:
Class Code:
Job Title:
Grade:
Hourly Rate:
The leave is to be transferred as follows:
_______ hours of annual leave
_______ hours of sick leave
_______ hours of special sick leave
________________________________________________________________________
________________________
Recipient's Appointing Authority
Date
Distribution: Donor, Donor's Appointing Authority
************************************************************************************************************************************
NOTICE OF RETURN OF EXCESS DONATED LEAVE
Pursuant to NRS 284.3621, _______ hours of leave donated by __________________________ were in excess of the amount of
catastrophic leave approved for use by ________________________________ and must be restored to the donor's account as follows:
_______ hours of annual leave
_______ hours of sick leave
_______ hours of special sick leave
________________________________________________________________________
________________________
Recipient's Appointing Authority
Date
Distribution: Donor, Donor's Appointing Authority
Catastrophic Leave Notice of Intent to Donate Leave/Request to Transfer Leave/Notice of Return of Excess Donated Leave
NPD-25
Page 1 of 2
Rev. 11.12
NOTICE OF INTENT TO DONATE LEAVE
Date:
Employee:
Employee ID#:
Agency:
Division:
Budget Account:
PC#:
Class Code:
Job Title:
Grade:
Hourly Rate:
I hereby declare my intent to donate leave to a catastrophic leave account as follows:
_______ hours to my agency's general catastrophic leave bank
_______ hours to the catastrophic leave account for use by:
Recipient’s name: ____________________________________________ Agency: _________________________
Leave is to be deducted from my account as follows:
_______ hours of annual leave
_______ hours of sick leave
_______ hours of special sick leave
I agree to allow my identity as a donor shared with the recipient upon the recipient’s request.
I certify that I have sufficient leave balances to make this election and that I will not by this authorization exceed the 120-hour
maximum leave donation in this calendar year.
__________________________________________________
__________________________________________________
Donor's Signature
Date
Appointing Authority
Date
Distribution: Donor's Appointing Authority, Recipient's Appointing Authority
************************************************************************************************************************************
REQUEST TO TRANSFER LEAVE
Pursuant to the above notice from ______________________________________, it is requested that _______ hours of leave be
transferred to the catastrophic leave account for:
Date:
Employee:
Employee ID#:
Agency:
Division:
Budget Account:
PC#:
Class Code:
Job Title:
Grade:
Hourly Rate:
The leave is to be transferred as follows:
_______ hours of annual leave
_______ hours of sick leave
_______ hours of special sick leave
________________________________________________________________________
________________________
Recipient's Appointing Authority
Date
Distribution: Donor, Donor's Appointing Authority
************************************************************************************************************************************
NOTICE OF RETURN OF EXCESS DONATED LEAVE
Pursuant to NRS 284.3621, _______ hours of leave donated by __________________________ were in excess of the amount of
catastrophic leave approved for use by ________________________________ and must be restored to the donor's account as follows:
_______ hours of annual leave
_______ hours of sick leave
_______ hours of special sick leave
________________________________________________________________________
________________________
Recipient's Appointing Authority
Date
Distribution: Donor, Donor's Appointing Authority
Catastrophic Leave Notice of Intent to Donate Leave/Request to Transfer Leave/Notice of Return of Excess Donated Leave
NPD-25
Page 1 of 2
Rev. 11.12
INSTRUCTIONS FOR THE COMPLETION
OF THE CATASTROPHIC LEAVE FORM
NOTICE OF INTENT TO DONATE LEAVE: This section must be completed by the employee who wishes to donate hours to an
account for catastrophic leave for use by a particular employee who has been approved to use them. It may also be used by an
employee who wishes to donate leave to his agency's general leave bank. In accordance with NRS 284.3621, an employee may not
donate any sick leave hours to a catastrophic leave account if the balance in his sick leave account after the transfer is less than 240
hours. Leave must be donated in increments of 8 hours up to a maximum of 120 hours in any one calendar year.
The employee shall submit the completed form to his appointing authority or designated representative for approval. The donor's
appointing authority shall verify the accuracy of the information on the form, verify the employee's leave balances, and certify that the
donation does not exceed the 120-hour maximum. Upon verification, the donor's appointing authority shall sign the completed form
and if the donation is specifically designated for use by a particular employee, forward a copy of it to the recipient's appointing
authority.
REQUEST TO TRANSFER LEAVE: This section must be completed by the recipient's appointing authority or designated
representative when leave hours specifically designated for use by a particular employee are needed. The completed request to
transfer leave must be submitted to the donor's appointing authority to effect transfer of leave hours from the donor's account to the
recipient's account. A copy must also be forwarded to the donor as notification that donated leave hours have been transferred.
In accordance with NAC 284.576, if more than one notice of intent to donate leave is received by the recipient's appointing authority
on behalf of the recipient, the notices must be maintained in chronological order and used, one at a time as needed, according to the
date in which the notices were received.
NOTICE OF RETURN OF EXCESS DONATED LEAVE: This section must be completed by the recipient's appointing authority
to return leave to the donor's account when leave transferred to the recipient's account is in excess of the amount approved for use or
needed by the recipient. A copy of the completed form must be forwarded to the donor's appointing authority to effect the return of
excess leave to the account from which it originated. A copy must also be forwarded to the donor as notification that leave hours are
being returned.
In accordance with NRS 284.3621, leave transferred in excess of the amount approved for use or needed by a particular employee
must be returned to the employee's account from which it originated. Any hours of annual or sick leave which are transferred from an
employee's account to the account for catastrophic leave and not designated for use by a particular employee may not be returned or
restored to the originating employee. NAC 284.576 requires that excess leave which is specifically designated for use by a particular
employee be restored to the account of the donor within 30 working days after the last day on which the recipient was eligible to
receive catastrophic leave.
Catastrophic Leave Notice of Intent to Donate Leave/Request to Transfer Leave/Notice of Return of Excess Donated Leave
NPD-25
Page 2 of 2
Rev. 11.12
Page of 2