GSA5022

FLSA Exemption Determination Checklist - Creative Professional Exemption

Agency
GSA
Revision
Rev. 11/2017
Fillable fields
5
Pages
2
Official source
GSA form page
Checked
October 20, 2026
Fill GSA5022 online
Page 1 of form GSA5022

GSA Form 5022: FLSA Exemption Determination Checklist, Creative Professional Exemption

GSA Form 5022, FLSA Exemption Determination Checklist, Creative Professional Exemption Checklist, is a General Services Administration (GSA) form, edition 11/2017, and GSA hosts it in its forms library. It is a two-page checklist of YES and NO questions about a position, leading to one result: EXEMPT or NON-EXEMPT under the FLSA creative professional exemption.

The questions cover a salary threshold, whether the position's primary duty requires invention, imagination, originality, or talent in a recognized field of artistic or creative endeavor, and whether that work is the position's primary duty, with references to 5 CFR 551.203, 5 CFR 551.209 and 5 CFR 551.104. A NO answer routes to the result block. The form says the employee should be marked as exempt only if you answered YES to all questions.

The PDF prints no name, signature, filing address or OMB number. 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 5022: FLSA Exemption Determination Checklist, Creative Professional Exemption, as printed by GSA

What's on GSA Form 5022

Item 1: salary threshold

Whether the annual rate of basic pay is equal to or greater than $23,660 for learned professionals other than professional legal positions, physician positions, or teacher positions. See 5 CFR 551.203.

Item 2: routing

If the answer to Question 1 is YES, go to item 3. If it is NO, go to item 6.

Item 3: creative work

Two parts joined by AND: a. work requiring invention, imagination, originality, or talent, and b. work in a recognized field of artistic or creative endeavor. A NO on either goes to item 6.

Item 4: routing

If the answers in Question 3 are YES, go to item 5. If any answer in Question 3 is NO, go to item 6.

Item 5: primary duty

Whether more than 50% of work time is spent on that work, or a duty under 50% may be credited if it meets three conditions printed on the form. See 5 CFR 551.104.

Result block

Under the heading Creative Professional Exemption, an EXEMPT box and a NON-EXEMPT box.

Five numbered items on the front and a result block on the back, which the routing rows call item 6.

How to complete GSA Form 5022

  1. 1

    Check the pay rate

    Answer item 1. The form says the rate of basic pay includes locality payments and special rate supplements before deductions, and does not include premium payments, differentials, and allowances.

  2. 2

    Answer the creative work questions

    Check YES or NO for items 3a and 3b. The form says work that can be produced by a person with general manual or intellectual ability and training does not meet item 3a.

  3. 3

    Follow the routing

    Items 2 and 4 and the NO column say where to go next. A NO answer goes to the result block on the back.

  4. 4

    Answer the primary duty question

    Check YES or NO for item 5 on whether the creative work is the primary duty of the position.

  5. 5

    Mark the result

    The form says to mark the employee exempt only if you answered YES to all questions. With a NO to any question, it says the employee does not meet the definition and is marked non-exempt.

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What the form says and does not say

Where it goes

The PDF gives no filing address or routing instructions, and prints no name, signature or date lines.

Pay figure as printed

The 11/2017 edition prints $23,660 as the annual rate of basic pay in item 1.

Regulations the form cites

5 CFR 551.203, 5 CFR 551.209, 5 CFR 551.104, 5 CFR part 531, Subpart F, and 5 CFR part 530, Subpart C.

What the PDF does not include

The PDF prints no OMB number, burden estimate or privacy notice, and GSA's page lists no authority or regulation for the form.

Related forms

Who uses GSA Form 5022?

  • The person making the determination

    The form speaks to the person answering: the employee should be marked as exempt only if you answered YES to all questions.

  • The position under review

    Each question is about this position or an employee in this position, starting with the annual rate of basic pay for the position.

  • Positions in creative fields

    Item 3 names music (musicians, composers, conductors and soloists), writing, acting, and graphic arts as recognized fields of artistic or creative endeavor.

  • The employee in the position

    The result block on the back marks the employee as EXEMPT or NON-EXEMPT.

The form does not name a job title for the person who completes it. It is written about a position and the employee in it.

Official sources and the blank

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Questions about Form GSA5022

Who issues GSA Form 5022?

The footer prints General Services Administration and GSA 5022 11/2017. GSA hosts the form in its forms library.

What pay figure does GSA Form 5022 print?

Item 1 asks whether the annual rate of basic pay is equal to or greater than $23,660 for learned professionals other than professional legal positions, physician positions, or teacher positions, and cites 5 CFR 551.203.

Which creative fields does the form name?

Item 3b lists music (musicians, composers, conductors and soloists), writing (writers who choose their own subjects and hand in a finished piece of work to their supervisor), acting, and graphic arts.

What does the form say about news and media work?

It says an employee in newspapers, magazines, television, or other media does not meet item 3a if he/she only collects, organizes, and records information that is routine or already public, or does not contribute a unique interpretation or analysis to a news product.

When is the employee marked exempt?

The form says the employee should be marked as exempt only if you answered YES to all questions. If you answered NO to any question, it says the employee does not meet the definition and is marked non-exempt.

Does GSA Form 5022 have a signature line?

No. The PDF prints no name, signature or date lines, only the questions and the YES, NO, EXEMPT and NON-EXEMPT boxes.