GSA Form 5051: Phased Retirement Mentoring Agreement

GSA Form 5051, Phased Retirement Mentoring Agreement, is a three-page General Services Administration (GSA) form, printed as GSA 5051 (REV. 3/2019). GSA hosts it in its forms library, and GSA's page lists HRM 9900.1 as its authority or regulation.

The form says that per GSA Phased Retirement Guidance and Procedures (HRM 9900.1), it officially documents the mentoring requirement during the period of phased employment or phased retirement. It defines mentoring broadly as any learning activities that allow the transfer of knowledge and skills from one employee to others or to the organization in general. The form explains that phased retirement allows an employee to work a 50 percent work schedule while mentoring others at least 20 percent of that time.

The employee answers four written questions and attaches a certificate of completion for a mentoring relationship course, and the supervisor and an authorizing official sign. 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 5051: Phased Retirement Mentoring Agreement, as printed by GSA

What's on GSA Form 5051

Blocks 1 to 8: employee information

Printed name, last 4 digits of SSN, office or division, duty location, title, series and grade, manager or supervisor, and the effective and ending dates of phased retirement.

The agreement

The purpose of phased retirement, management's knowledge transfer responsibilities, and three points employees approved for phased retirement agree to.

Questions 9 and 10: knowledge at risk

The specialized programs, projects or services jeopardized by the retirement, and the qualifications, competencies, services and specialized knowledge and skills that can be transferred to others.

Questions 11 and 12: mentoring history

Mentoring, training or coaching the employee has received, and experience mentoring and coaching others.

Blocks 13 to 23: decisions and signatures

Agency comments, recommended and approved boxes, and printed names, signatures and dates for the employee, supervisor and authorizing official.

How to complete GSA Form 5051

1
Fill in employee information
Blocks 1 to 8 ask for the employee and supervisor details and the effective and ending dates of phased retirement.
2
Answer questions 9 to 12
The form asks for detailed responses and says to attach additional sheets if necessary.
3
Attach the training certificate
Attach a certificate of completion for a course on mentoring relationship training available in GSA's current learning management system.
4
Sign and date
The employee prints a name, signs and dates in blocks 15 to 17, followed by the supervisor and the authorizing official.
5
Record the decision
Blocks 13 and 14 mark the agreement recommended and approved, YES or NO. The form says the reason for a disapproval is identified in the agency comments.

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Mentoring terms and what the form says

Where it goes

The PDF gives no filing address. It points to GSA Phased Retirement Guidance and Procedures (HRM 9900.1).

Mentoring time

At least 20 percent or more of working hours, which the form gives as 4 hours per week or 8 hours per pay period.

What counts as mentoring

The form says any learning activities that allow for the transfer of knowledge and skills from one employee to others or to the organization in general.

Required attachment

A certificate of completion for a course on mentoring relationship training available in GSA's current learning management system.

Who completes GSA Form 5051?

Employees approved for phased retirement
The form says employees approved for participation complete this agreement, attach a mentoring training certificate and take part in knowledge capture, knowledge transfer and mentoring activities.
Management
The form says management is responsible for a knowledge transfer and mentoring process: identifying critical knowledge, capturing it, confirming its transfer and validating its application.
Manager or supervisor
The manager or supervisor is named in block 6 and prints a name, signs and dates in blocks 18 to 20.
Authorizing official
An authorizing official prints a name, signs and dates in blocks 21 to 23. Blocks 13 and 14 hold recommended and approved boxes.

The form lists what employees approved for phased retirement agree to, and has places for three signers.

Official sources and the blank

Official GSA form page
The agency’s own page for Form GSA5051.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form GSA5051

Who issues GSA Form 5051?

The footer reads GENERAL SERVICES ADMINISTRATION and GSA 5051 (REV. 3/2019). GSA hosts it in its forms library, and its page lists HRM 9900.1 as the authority or regulation.

Who fills out GSA Form 5051?

Employees approved for participation in phased retirement. The supervisor and an authorizing official also sign, below recommended and approved boxes.

How much time goes to mentoring?

The form says at least 20 percent or more of working hours, which it gives as 4 hours per week or 8 hours per pay period.

What does the form ask the employee to describe?

Programs, projects or services jeopardized by the retirement, knowledge and skills that can be transferred, mentoring received, and mentoring and coaching provided to others.

What is attached to GSA Form 5051?

A certificate of completion for a course on mentoring relationship training available in GSA's current learning management system, and additional sheets if the answers need more room.

GSA Form 5051: Phased Retirement Mentoring Agreement