GSA Form 3637: Severance Pay Worksheet

GSA Form 3637, Severance Pay Worksheet, is a General Services Administration form. Its footer reads GSA FORM 3637 (REV. 12-93) and Prescribed by OAD P 9550.1, the same authority GSA's forms page lists, and GSA hosts it in its forms library.

The one-page worksheet works through an employee's severance pay in five parts: I. Service, II. Age, III. Weekly Rate, IV. Severance Pay Fund and V. Severance Payments. Each line prints its own arithmetic, such as Item g + (2 * Item h). It ends with a certification signed and dated by a personnel specialist. It prints no instructions, no OMB number and no privacy statement.

You can fill it out free in your browser on this page and download the result without an account.

Top of page 1 of GSA Form 3637: Severance Pay Worksheet, as printed by GSA

What's on GSA Form 3637

Part I: Service

Separation date, SCD leave, service, a DD 214 date, service after subtracting it, total years, service to 10 years, service over 10 years, and number of weeks as Item g + (2 * Item h).

Part II: Age

Separation date, date of birth, age, age over 40 (Item d - 40) and an age factor (Item e/10).

Part III: Weekly Rate

Per annum: adjusted rate, hourly rate (Item a/2087), standby percent, standby rate, hourly rate and weekly rate (Item e * 40). Per hour: hourly rate, night differential, full hourly rate and weekly rate (Item i * 40).

Part IV: Severance Pay Fund

Basic allowance, age adjustment, raw fund, 52 weeks pay, fund (the lesser of Item c and d), prior weeks severance pay, their value and the final fund (Item e - Item g).

Part V: Severance Payments and certification

Weekly rate, weeks (Item IVh/Item a), biweekly payment (Item a * 2) and final payment, then the personnel specialist's signature and date.

How to complete GSA Form 3637

1
Enter the employee
Name (last, first) and Social Security number. Dates and service lengths are written YY/MM/DD, as printed beside each line.
2
Work out service
Part I subtracts the SCD leave date from the separation date, then the DD 214 entry, and turns the years into a number of weeks.
3
Work out the age factor
Part II finds the age at separation, the years over 40 and the age factor (Item e/10).
4
Use one rate block
Part III has a per annum block ending in Item IIIf and a per hour block ending in Item IIIj. Parts IV and V refer to one or the other.
5
Compute the fund and payments
Part IV builds the fund, limits it to the lesser of the raw fund and 52 weeks pay and subtracts any prior severance. Part V turns it into weeks and biweekly payments.
6
Certify
A personnel specialist signs and dates the certification line.

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Routing and what the form says

Who certifies it

The certification block is signed and dated by a personnel specialist. The form prints no routing address.

Prescribing document

The footer reads Prescribed by OAD P 9550.1. GSA's forms page lists the same authority and a current revision date of 12/1993.

Prior severance pay

The form says: If you received previous severance pay, your benefits will be reduced. Lines g and h of Part IV subtract its value from the fund.

What the form does not print

No instructions, no OMB number and no privacy statement.

Who fills out GSA Form 3637?

Personnel specialist
The certification block is for the signature of a personnel specialist, with the date.
The separating employee
The header takes the employee's name (last, first) and Social Security number. The form has no signature line for the employee.
Employees with prior severance pay
Line f of Part IV counts prior weeks of severance pay. The form says: If you received previous severance pay, your benefits will be reduced.
Annual or hourly rates
Part III has a per annum rate block, with standby lines, and a per hour rate block, with a night differential line.

The form prints no instructions. Its header and certification block show these roles.

Official sources and the blank

Official GSA form page
The agency’s own page for Form GSA3637.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form GSA3637

Who signs GSA Form 3637?

The certification block is for the signature of a personnel specialist, with the date. There is no signature line for the employee.

What date format does the worksheet use?

Dates and service lengths are entered as YY/MM/DD, as printed beside each date line.

What does prior severance pay change?

The form says: If you received previous severance pay, your benefits will be reduced. Part IV values the prior weeks at the weekly rate and subtracts that from the fund.

How is the hourly rate figured from an annual rate?

Line b of Part III divides the adjusted rate by 2087, printed as HOURLY RATE (Item a/2087). The weekly rate is the hourly rate times 40.

Is the fund limited?

Line d of Part IV is 52 weeks pay, and line e takes the lesser of the raw fund and the 52 weeks pay.

GSA Form 3637: Severance Pay Worksheet