U.S. FISH WILDLIFE SERVICE PCS Lump Sum Pilot . FISH & WILDLIFE SERVICE PCS Lump Sum Pilot ... Relocation…

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    07-Jul-2018

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<ul><li><p>U.S.FISH&amp;WILDLIFESERVICEPCSLumpSumPilotAdvanceofFundsApplication</p><p>FWS3248508/16</p><p>TheServiceusesthisformtoprocesstheinitialportionofaPermanentChangeofStation(PCS)lumpsumpaymentasanadvance.TheRelocationCounselorandemployeecompletethisformwithForm3139Aiftheemployeeselectsthelumpsumpaymentmethod.</p><p>SECTIONA:IDENTIFYINGINFORMATION</p><p>Name(First,MiddleInitial,Last):</p><p>EmployeeIdentificationNumber(EIN):</p><p>DateReportingtoNewDutyStation:</p><p>SECTIONB:ADVANCEOFFUNDSINFORMATION</p><p>ThepaymentamountisdeterminedduringtherelocationcounselingprocessanddocumentedonForm3139A.Thepurposeofthisformistoprocess74%oftheportionofthelumpsumpaymentthatisavailableupfrontasanadvance.</p><p>Ifemployeequalifiesforcompensationforsaleofprimaryresidence:</p><p>TotalLumpSumPaymentAmount:</p><p>PortionAvailableUpFront(74%oftotalpayment):</p><p>AmountHeldtoCoverTaxes(26%ofupfrontportion):</p><p>AmounttobePaidasAdvance(74%ofupfrontportion):</p><p>Ifemployeedoesnotqualifyforcompensationforsaleofprimaryresidence:</p><p>TotalLumpSumPaymentAmount:</p><p>AmountHeldtoCoverTaxes(26%oftotalpayment):</p><p>AmounttobePaidasAdvance(74%oftotalpayment):</p><p>SECTIONC:REQUIREDSIGNATURES(ElectronicsignaturesacceptableunlessRegionalpolicyrequireshardcopysignaturesonPCSforms)</p><p>IamparticipatinginthePCSlumpsumpilotprogramandagreetoreceivetheportionofmylumpsumpaymentidentifiedinSectionBasanadvance.IagreetoappearatmynewdutystationonthedatespecifiedbytheServiceandunderstandthefundingprovidedperSectionBissubjecttothetermsandconditionsinmyEmployeeRelocationAgreement.IntheeventthatIfailtoremainintheFederalGovernmentserviceforaperiodof12monthsfollowingtheeffectivedateofmytransfer,unlessseparatedforreasonsbeyondmycontrolandacceptabletotheService,thelumpsumpayment(s)issuedtomeshallberecoverablefrommeasadebtduetotheUnitedStates(28U.S.C.2514).</p><p>________________________________________________________ApplicantSignatureDate</p><p>MysignatureconfirmsthattheemployeerequirestheadvanceinSectionBtocompletehis/herrelocation.</p><p>_________________________________________________________RelocationCounselorSignatureDate</p><p>IapprovetheemployeetoreceivetheadvanceoffundsasindicatedinSectionBofthisform.</p><p>_________________________________________________________ApprovingOfficialSignature(FWS)Date</p><p>_________________________________________________________AuthorizedCertifyingOfficialSignature(IBC)Date</p><p>Employee_Name: Employee_EIN: RE_Total: NoRE_Total: RE_UpFront: 0NoRE_Held: 0RE_Held: 0NoRE_Advance: 0RE_Advance: 0Employee_Date: RC_Date: AO_Date: ACO_Date: Report_Date: </p></li></ul>