Page 1: employee and departure
Employee's name, effective date of separation, last active date if different, supervisor's name, office or division, organization code and reason for departure.
GSA1655
Pre-Exit Clearance Checklist
- Agency
- GSA
- Revision
- Rev. 8/2026
- Fillable fields
- 80
- Pages
- 7
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 1655: Pre-Exit Clearance Checklist
GSA Form 1655, Pre-Exit Clearance Checklist, is a General Services Administration form, Rev. 8/2026 (printed GSA 1655 (REV. 8/2026)), and GSA hosts it in its forms library. GSA's page lists HRM 7800.14B as its authority or regulation, and the form's instructions point to HRM 7800.14, Pre-Exit Clearance Guidance and Procedures for all Separations.
The form says the checklist applies to all permanent and temporary GSA Federal employees departing GSA due to resignation, retirement, or transfer to another agency. Page 1 records the employee, supervisor, office, separation dates and reason for departure. Pages 2 and 3 list 32 items, 16 process and financial obligation items and 16 property return items, each marked Completed (Initial/Date) or N/A. Page 4 holds additional information and the employee and supervisor certifications, and pages 5 to 7 give instructions for each item.
You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 1655
Items 1 to 16: process and financial items
Travel vouchers and advances, transit benefits, child care, fitness center, contracting officer's warrant, service agreements, advance leave, leave transfer, Health Unit, parking, IT offboarding ticket, file access, voice mail and government cell phone.
Items 17 to 28: property return
IT equipment, official passport, purchase card documents, travel charge card, GETS and COOP materials, other equipment, non-IT and telework items, office files, controlled-area access, office keys, security clearance debriefing and PIV card.
Items 29 to 32: debts and records
Any indebtedness to the Government from an incomplete clearance, the performance plan close-out in HR Links, a records transfer meeting and the home address in HR Links.
Page 4: certifications
Additional information for unresolved items, the employee's certification and signature, a note on GSA's confidential exit survey, and the supervisor's certification and signature.
Pages 5 to 7: instructions
One instruction per item, naming the office or mailbox to contact and when the supervisor notifies the Payroll Services Branch to hold the final paycheck.
How to complete GSA Form 1655
- 1
Start early
The form says departing employees should begin the process at least ten (10) business days before their separation date, first reviewing the Offboarding InSite page for notification instructions.
- 2
Fill in page 1
Enter the employee, separation dates, supervisor, office or division, organization code and reason for departure.
- 3
Work through items 1 to 32
The form says each item is marked as appropriate if applicable, on or before the last day of employment, with an initial and date under Completed or a mark under N/A.
- 4
Follow each item's instructions
Pages 5 to 7 say whom to contact for each item, such as the IT Service Desk on (866) 450-5250 for equipment pickup or the Personnel Security Office for a clearance debriefing.
- 5
Explain unresolved items
The Additional Information section asks for a justification for items that were not resolved. The form says the supervisor documents the reason if an item is not complete before the employee departs.
- 6
Sign and keep a copy
The employee and the supervisor (or designee) sign and date their certifications. The losing organization keeps an electronic copy for not less than one year from the date of certification.
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Routing, records and what the form says
Questions
The form says to send questions to [email protected].
Insider threat reporting
The form says all offices report pre-exit and separation anomalies, like failure to return Government furnished equipment and personal property, to the Insider Threat Program at [email protected].
PIV card by mail
For offsite employees, the instructions give this address: U.S. General Services Administration, GSA Office of Mission Assurance, ATTN: HSPD-12 Branch (DBB), 1800 F Street, NW, Washington, DC 20405.
Final paycheck
In the employee certification, the employee states an understanding that failure to return all property could lead to a claim of Indebtedness to the Government, including the withholding of the final paycheck.
Record keeping
The form says each losing organization retains an electronic copy of the certified GSA 1655 and supporting information until no longer needed, but not less than one year from the date of certification.
Exit survey
Page 4 asks departing employees to take 5 minutes to complete GSA's confidential exit survey.
Related forms
Who fills out GSA Form 1655?
The instructions on page 1 describe these roles. The form is for GSA's own employees, not the public.
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Questions about Form GSA1655
Who uses GSA Form 1655?
The form says it applies to all permanent and temporary GSA Federal employees departing GSA due to resignation, retirement, or transfer to another agency, together with their supervisor.
When does the pre-exit clearance start?
The form says departing employees should begin at least ten (10) business days before their separation date, and that lack of advance notice does not remove the responsibility to complete the applicable items.
What if an item cannot be completed?
The form says the supervisor documents the reason on the form, and the Additional Information section asks for a justification for items that were not resolved.
How is a PIV card returned from offsite?
The instructions say to mail it to the GSA Office of Mission Assurance, ATTN: HSPD-12 Branch (DBB), 1800 F Street, NW, Washington, DC 20405, or to place it in the box with the IT equipment.
Who keeps the completed form?
The form says each losing organization retains an electronic copy of the certified GSA 1655, with supporting information, for not less than one year from the date of certification.
Where do questions go?
The form says to send questions to [email protected].
What happens if property is not returned?
For several items, the instructions say the supervisor notifies the Payroll Services Branch (BGC) at [email protected] to put a hold on the final paycheck, and some items are also reported to the Insider Threat Program.