DTIC
Request for Leave or Approved Absence 1. Name (Last, first, middle) 3. Organization 2. Employee or Social Security Number XXX-XX- 4. Check appropriate box(es) and enter date and time below Type of Leave/Absence Date From To From Time To Total Hours 5. Family and Medical Leave Accrued annual leave Restored annual leave Advance annual leave Accrued sick leave Advance sick leave Purpose: Illness/injury/incapacitation of requesting employee Medical/dental/optical examination of requesting employee MoreOPM Form 71. June 2001. Formerly Standard Form (SF) 71 ... regarding a claim; to Federal Life Insurance or Health Benefits carriers regarding a claim; to a Less
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