NOTIFICATION OF PERSONNEL ACTION

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-03721A000600010008-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: December 16, 2016
• Document Release Date: June 14, 2005
• Sequence Number: 8
• Content Type: FORM

REMARKS
NOTIFICATION OF PERSONNEL ACTION
1. SERIAL NUMBER
2. NAME (LAST-FIRST-MIDDLE)
3. NATURE OF PERSONNEL ACTION DES I GNAT I N AS
4. EFFECTIVE DATE
5. CATEGORY OF EMPLOYMENT
PARTICIPANT I N THE CIA RETIREMENT
MO. DA. YR.
AND DISABILITY SYSTEM
1 I
V TO V
V TO CF
7. COST CENTER NO. CHARGEABLE
B. CSC OR OTHER LEGAL AUTHORITY
6
FUNDS
.
CF TO V
CF TO CF
PUBLIC LAW 88-643
9. ORGANIZATIONAL DESIGNATIONS
10. LOCATION OF OFFICIAL STATION
11. POSITION TITLE
12. POSITION NUMBER
13. SERVICE DESIGNATION
14. CLASSIFICATION SCHEDULE (GS, LB, etc.)
15. OCCUPATIONAL SERIES
16. GRADE AND STEP
17. SALARY OR RATE
ARE
HEREBY
NOTIFIED
U IFIED OF YOUR RIGHT TO APPEAL THIS ACTION TO THE
RECTOR OF CENTRALINTELLI ENCE IN ACCORDANCE WITH THE APPEAL
PROCEDURES
ESTABLISHED
INI
SPACE BELOW FOR EXCLUSIVE USE OF THE OFFICE OF PERSONNEL
19. ACTION
CODE
20. Employ.
Code
21. OFFICE CODING 22. STATION 23. INTEGREE
CODE CODE
24. Hdgtrs.
Cod.
25. DATE OF BIRTH
26. DATE OF GRADE
27. DATE OF LEI
NUMERIC ALPHABETIC
MO. DA. YR.
MO. DA. YR.
MO. DA. YR.
28. NTE EXPIRES
29. SPECIAL 30. RETIREMENT DATA 31. SEPARATION
I I
32. CORRECTION/CANCELLATION DATA
I
33. SECURITY 34. SEX
Mo. DA. YR.
REFERENCE I - CSC
CODE DATA CODE
TYPE
MO. DA. YR.
REQ. NO.
3 - FICA
EOD DATA
1 1
5 - NONE
35. VET. PREFERENCE
36. SERV. COMP. DATE
37. LONG. COMP. DATE
38. CAREER CATEGORY
39. FEGLI / HEALTH INSURANCE
40. SOCIAL SECURITY NO.
CODE
0 - NONE
1 - 5 PT.
MO. DA. YR.
MO. DA. YR.
CAR. RESV
CODE
CODE
0 - WAIVER
HEALTH INS. CODE
2 10 PT.
I I
PROV. TEMP.
I -YES
41. PREVIOUS GOVERNMENT SERVICE DATA
42. LEAVE CAT.
43. FEDERAL TAX DATA
44. STATE TAX DATA
CODE
0 - NO PREVIOUS SERVICE
CODE
FORM EXECUTED
CODE
NO, TAX EXEMPTIONS
FORM EXECUTED
CODE
NO.TAX
STATECODE
I - NO BREAK IN SERVICE
I - YES
I - YES
EXEMP.
2 - BREAK IN SERVICE (LESS THAN 3 YRS.)
2 - NO
2 - NO
3 - BREAK IN SERVICE (MORE THAN 3 YRS.)
SIGNATURE OR OTHER AUTHENTICATION
FORM 1150 Use revious SECRET
GROUP 1
(4-51)
fl-62 Edition
Excluded from automatic
downgrading and
declassification
(When Filled In)
25X
;.. SECRET .e.
Ije