Form PAY-23B "Formal Appeal to Committee on Catastrophic Leave" - Nevada

What Is Form PAY-23B?

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 January 1, 2015;
  • 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 PAY-23B by clicking the link below or browse more documents and templates provided by the Nevada Department of Administration.

ADVERTISEMENT
ADVERTISEMENT

Download Form PAY-23B "Formal Appeal to Committee on Catastrophic Leave" - Nevada

Download PDF

Fill PDF online

Rate (4.4 / 5) 33 votes
Formal Appeal to Committee on Catastrophic Leave
Pursuant to NRS 284.362 to 284.3629, an employee that is aggrieved by a decision of an
appointing authority may appeal the decision by filing a written notice of appeal with the
committee within 10 days after the date of the appointing authority's decision.
Name of Appellant:____________________________________ Employee ID #: ____________
Mailing Address:_________________________ City:____________ State:____ Zip: _________
Home Phone:____________________________ Work Phone: ___________________________
Class Title:_____________________ Department:_______________ Division: ______________
Date Catastrophic Leave Requested:__________ Date Catastrophic Leave Denied: ___________
Describe how you have been aggrieved by the appointing authority’s decision (NRS 284.362 to
284.3629). Please be specific.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please attach a copy of the denied Request to Receive Catastrophic Leave Donations form (PAY-
23) and Physician’s Certification for Catastrophic Leave Request – Employee form (PAY-23CE)
or Physician’s Certification for Catastrophic Leave Request – Immediate Family Member form
(PAY-23CF) and any other pertinent documentation to this form and submit to:
Committee on Catastrophic Leave
c/o Clerk to the Committee
100 N. Stewart St., Suite 200
Carson City, Nevada 89701
Fax (775) 684-0118
Email: CatLeaveCoordinator@admin.nv.gov
Rev. 1/15
Formal Appeal to Committee on Catastrophic Leave (PAY-23B)
Page 1 of 1
Formal Appeal to Committee on Catastrophic Leave
Pursuant to NRS 284.362 to 284.3629, an employee that is aggrieved by a decision of an
appointing authority may appeal the decision by filing a written notice of appeal with the
committee within 10 days after the date of the appointing authority's decision.
Name of Appellant:____________________________________ Employee ID #: ____________
Mailing Address:_________________________ City:____________ State:____ Zip: _________
Home Phone:____________________________ Work Phone: ___________________________
Class Title:_____________________ Department:_______________ Division: ______________
Date Catastrophic Leave Requested:__________ Date Catastrophic Leave Denied: ___________
Describe how you have been aggrieved by the appointing authority’s decision (NRS 284.362 to
284.3629). Please be specific.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please attach a copy of the denied Request to Receive Catastrophic Leave Donations form (PAY-
23) and Physician’s Certification for Catastrophic Leave Request – Employee form (PAY-23CE)
or Physician’s Certification for Catastrophic Leave Request – Immediate Family Member form
(PAY-23CF) and any other pertinent documentation to this form and submit to:
Committee on Catastrophic Leave
c/o Clerk to the Committee
100 N. Stewart St., Suite 200
Carson City, Nevada 89701
Fax (775) 684-0118
Email: CatLeaveCoordinator@admin.nv.gov
Rev. 1/15
Formal Appeal to Committee on Catastrophic Leave (PAY-23B)
Page 1 of 1