GSA5027
FLSA Exemption Determination Checklist - Foreign Exemption
GSA Form 5027 is the FLSA Exemption Determination Checklist for the Foreign Exemption, a two-page General Services Administration form, edition 11/2017. The PDF prints FLSA EXEMPTION DETERMINATION CHECKLIST with the subheading Foreign Exemption Checklist, and its footer reads GENERAL SERVICES ADMINISTRATION. GSA hosts it in its forms library.
The checklist asks whether the employee first worked all hours in a workweek in an exempt area, which the form defines as any foreign country or territory under U.S. jurisdiction other than Puerto Rico, the U.S. Virgin Islands, Outer Continental Shelf Lands, American Samoa, Guam, Commonwealth of Northern Mariana Islands, Midway Atoll, Wake Island, Johnston Island, and Palmyra. It then covers employees permanently stationed in an exempt area who spend any hours of work in a non-exempt area, with same duties and different duties tests that refer to 5 CFR 551.211. The last question has EXEMPT and NON-EXEMPT boxes.
Several answers ask for attached documentary evidence. The form prints no name, signature or date line and no filing address. You can fill it out free in your browser on this page and download the result without an account.
Whether the employee first worked all hours in a workweek in an exempt area. The form says the minimum wage, overtime, and child labor provisions do not apply to any employee who spends all hours of work in a given workweek in an exempt area.
If Question 1 is YES, the form says to move to Question 4. If NO, it says the foreign exemption does not apply, and the NO box reads STOP.
Employees permanently stationed in an exempt area who spend any hours of work in a non-exempt area. The form lists the non-exempt areas and asks three questions about notifying HR, reassessing exemption status and comparing primary duties.
Part a, same duties, and part b, different duties in Parts I and II, ask whether the employee would qualify for another exemption. Part II applies the rules for temporarily performing different work under 5 CFR 551.211.
EXEMPT and NON-EXEMPT boxes under the heading Foreign Exemption.
Check YES or NO for Question 1 on whether the employee first worked all hours in a workweek in an exempt area.
The form says a YES moves to Question 4. A NO means the foreign exemption does not apply, and the box reads STOP.
For an employee permanently stationed in an exempt area who works any hours in a non-exempt area, answer the three procedure questions in Question 3.
Answer part a, same duties, or part b, different duties Parts I and II. The form asks for documentary evidence, the relevant exemption status checklist and, for Part II, the completed Temporarily Performing Duties Checklist.
The form says to mark EXEMPT only if you answered YES to Question 1 OR 3a OR b Parts I & II, and NON-EXEMPT if you answered NO to Question 3a AND b.
These steps follow the routing printed on the form.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The form prints no filing address, routing or signature line.
Documentary evidence for the primary duties question and the same or different duties tests, the relevant exemption status checklist, and the completed Temporarily Performing Duties Checklist.
5 CFR 551.211, for the rules on temporarily performing different work.
The footers print GSA 5027 11/2017 and GSA 5027 11/2017 BACK. GSA's page lists 11/2017 as the current revision date and leaves Authority or Regulation blank.
GSA5030
17 fields, 3 pages
GSA5026
7 fields, 1 page
GSA5025
7 fields, 2 pages
GSA5023
6 fields, 2 pages
GSA5029
6 fields, 2 pages
GSA5021
4 fields, 2 pages
The form does not say which office completes it. Its questions refer to the employee and to the person answering as you.
No tool matches that search.
The form's footer reads GENERAL SERVICES ADMINISTRATION. GSA hosts it in its forms library.
The form defines exempt areas as any foreign country or territory under U.S. jurisdiction, other than Puerto Rico, the U.S. Virgin Islands, Outer Continental Shelf Lands, American Samoa, Guam, Commonwealth of Northern Mariana Islands, Midway Atoll, Wake Island, Johnston Island, and Palmyra.
The form says employees who at first qualify for the foreign exemption lose their exempt status once they work any hours in a non-exempt area during a workweek, and must re-qualify for the foreign exemption once they return to an exempt area.
Documentary evidence supporting several answers, the relevant exemption status checklist, and the completed Temporarily Performing Duties Checklist for the different duties test.
No signature, name or date line is printed on either page.
