Form NIH2992 "Administrative Leave Request"

What Is Form NIH2992?

This is a legal form that was released by the U.S. Department of Health and Human Services - National Institutes of Health on August 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2018;
  • The latest available edition released by the U.S. Department of Health and Human Services - National Institutes of Health;
  • 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 Form NIH2992 by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - National Institutes of Health.

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Download Form NIH2992 "Administrative Leave Request"

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DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Administrative Leave Request
Employee Information
Employee Name
IC
Series
Grade
Admin. Leave
Extension (Additional Days)
Total
Start
Days
NDAA Leave Guidelines: General Leave (Max 10 calendar days per year), Investigative Leave (10 days, 30 day extensions up to 120 days with
approval), Notice Leave (30 days) Weather & Safety (no stated limit, but telework encouraged as an option).
Requestor Information
Requestor Name
Title
IC
Date of Request
Summary of Request
Notice
General
Investigative
Please Provide the Basis of this Request
Are there Concerns about the Employee Behavior or Welfare?
Yes
No
If "Yes", please explain:
Date Contacted
Has Civil been Contacted?
Yes
No
Is there another Option (ie: Temporary Reassignment, Telework, Detail, etc.)?
Yes
No
If "No", please explain:
OHR Concurrence and Recommendation
Approval Signature
Total Initial Days Approved
The undersigned IC Executive Officer or designee has reviewed and approved the initial
Administrative Leave Request
Extension Approval Signature
Total Days Approved
(includes Initial Approval days)
The undersigned IC Executive Officer or designee has reviewed and approved the Administrative
Leave Request extension
NIH 2992 (08/18)
EF
PSC Publishing Services (301) 443-6740
DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Administrative Leave Request
Employee Information
Employee Name
IC
Series
Grade
Admin. Leave
Extension (Additional Days)
Total
Start
Days
NDAA Leave Guidelines: General Leave (Max 10 calendar days per year), Investigative Leave (10 days, 30 day extensions up to 120 days with
approval), Notice Leave (30 days) Weather & Safety (no stated limit, but telework encouraged as an option).
Requestor Information
Requestor Name
Title
IC
Date of Request
Summary of Request
Notice
General
Investigative
Please Provide the Basis of this Request
Are there Concerns about the Employee Behavior or Welfare?
Yes
No
If "Yes", please explain:
Date Contacted
Has Civil been Contacted?
Yes
No
Is there another Option (ie: Temporary Reassignment, Telework, Detail, etc.)?
Yes
No
If "No", please explain:
OHR Concurrence and Recommendation
Approval Signature
Total Initial Days Approved
The undersigned IC Executive Officer or designee has reviewed and approved the initial
Administrative Leave Request
Extension Approval Signature
Total Days Approved
(includes Initial Approval days)
The undersigned IC Executive Officer or designee has reviewed and approved the Administrative
Leave Request extension
NIH 2992 (08/18)
EF
PSC Publishing Services (301) 443-6740