GSA873A_15
Annual Attendance Record (Part Time Employees) - 2015
GSA Form 873A, Annual Attendance Record (Part-Time Employees) - 2015, is a General Services Administration form, GSA 873A (REV. 12/2014). GSA hosts it in its forms library. The footer also reads (Also known as OF 873A).
The form says it is an optional form for timekeepers to use in recording daily and bi-weekly pay and leave activity, and that it is a record of what SHOULD BE recorded into the official payroll system. It says the bi-weekly Earnings and Leave Statement, the Supervisor's Time and Attendance Report and the Premium Pay Report reflect what IS in the official payroll system, and that those reports should agree with the data on this form.
The front holds one row for each 2015 pay period, from code 3 (1/11 - 1/24) to code 27 (12/13 - 12/26), then code 1 (12/27 - 1/9), with a box for each day, annual and sick leave columns and an Employee block. The back has columns for other types of leave categories. The form is marked "Sensitive, but Unclassified". You can fill it out free in your browser on this page and download the result without an account.
The legend lists A = Annual Leave, S = Sick Leave, E = Excused, W = Absent Without Leave, CE = Compensation Time Earned, CU = Compensation Time Used, OT = Overtime, M = Military Leave, R = Restored Leave, D = Award Leave, L = Leave Without Pay and C, printed as Continuation of Pay for Traumatic. H marks a holiday and a black square marks the last day of a month.
For leave categories 4, 6 and 8, annual leave is 1 Hour per 20 worked, 1 Hour per 13 worked and 1 Hour per 10 worked. For sick leave the form says 1 Hour is earned for each 20 worked, regardless of category.
One row per pay period, from code 3 (1/11 - 1/24) to code 27 (12/13 - 12/26), then code 1 (12/27 - 1/9), with a box for each day from Sunday to Saturday over two weeks. Holidays come printed as H.
Each side has a carryover with leave hours and work hours, then total hours worked, hours applied to leave earned, balance of hours worked, leave earned and used this pay period, used to date and the balance.
Address, name, telephone number, leave category code, block number, service computation date and entered on or transmittal date, plus a Tour of Duty box in the top corner.
The back repeats the pay periods under untitled columns. The form gives Shared (Donated), Restored, Award, Family Friendly (Sick or Medical), Military, Compensatory Leave and Credit Hours as examples of leave categories, and Environmental Differential Pay, Sunday Premium, Night Differential and Overtime as premium pay hours.
The front is one grid for the 2015 leave year. The back adds columns for other leave categories.
Fill in the Employee block at the bottom: name, address, telephone number, leave category code, block number, service computation date and entered on or transmittal date. The Tour of Duty box sits in the top corner.
Enter codes in the day boxes for each pay period. The legend lists suggested codes such as A for Annual Leave and S for Sick Leave, and holidays are already printed as H.
In the annual and sick leave columns, enter total hours worked, hours applied to leave earned, the balance of hours worked, leave earned and used this pay period, used to date and the balance.
The form says the untitled columns may be used to maintain usage and balances for any leave and premium pay categories that may apply for an individual employee.
The form says the bi-weekly Earnings and Leave Statement, the Supervisor's Time and Attendance Report and the Premium Pay Report should agree with the data on this form.
The PDF has no line-by-line instructions. These steps follow the blocks it prints.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The PDF gives no filing address or recipient. It describes itself as a record of what should be recorded into the official payroll system.
The footer reads GSA 873A (REV. 12/2014) and PREVIOUS EDITION IS NOT USABLE. GSA's page lists a current revision date of 12/2014.
The form is marked "Sensitive, but Unclassified" on the front.
The PDF prints no signature line, OMB number, burden estimate or Privacy Act statement.
OF873A_15
1,217 fields, 2 pages
GSA873_15
1,142 fields, 2 pages
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GSA873A_16
1,216 fields, 2 pages
GSA873A
1,215 fields, 2 pages
The form describes itself as a timekeeper's record. It prints no signature line, filing address or OMB number.
No tool matches that search.
The form says it is an optional form for timekeepers to use in recording daily and bi-weekly pay and leave activity.
The form says it is a record of what SHOULD BE recorded into the official payroll system, while the bi-weekly Earnings and Leave Statement, the Supervisor's Time and Attendance Report and the Premium Pay Report reflect what IS in that system and should agree with it.
The Leave Earned table gives annual leave as 1 Hour per 20 worked for category 4, 1 Hour per 13 worked for category 6 and 1 Hour per 10 worked for category 8. For sick leave it says 1 Hour is earned for each 20 worked, regardless of category.
The legend lists A = Annual Leave, S = Sick Leave, E = Excused, W = Absent Without Leave, CE = Compensation Time Earned, CU = Compensation Time Used, OT = Overtime, M = Military Leave, R = Restored Leave, D = Award Leave, L = Leave Without Pay and C, printed as Continuation of Pay for Traumatic. H marks a holiday and a black square marks the last day of a month.
From code 3 (1/11 - 1/24) to code 27 (12/13 - 12/26), then code 1 (12/27 - 1/9).
The PDF prints no filing address, recipient or signature line. It says it is for timekeepers to use in recording pay and leave activity.
GSA's forms library also lists GSA Form 873A, Annual Attendance Record (Part-Time Employees) - 2026, Rev. 1/2026.