GSA873A_21
Annual Attendance Record (Part-Time Employees) - 2021
GSA Form 873A, Annual Attendance Record (Part-Time Employees) - 2021, is a U.S. General Services Administration (GSA) form, Rev. 6/2021, and GSA hosts it in its forms library. The front is marked Sensitive, but Unclassified.
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. The front holds a daily grid for the 26 pay periods of 2021, the leave earning rates for leave categories 4, 6 and 8, and running annual and sick leave balances. The back has untitled columns for other leave and premium pay categories.
You can fill it out free in your browser on this page and download the result without an account.
A black square marks the last day of each month and H marks a holiday. The suggested codes are A for Annual Leave, S for Sick Leave, E for Excused, W for Absent Without Leave, M for Military Leave, R for Restored Leave, D for Award Leave, L for Leave Without Pay, CE for Compensation Time Earned, CU for Compensation Time Used, OT for Overtime and C for Continuation of Pay for Traumatic, as printed.
For leave categories 4, 6 and 8 the form prints annual leave earned per pay period of 1 hour per 20, 13 and 10 hours worked. For sick leave it says 1 hour is earned for each 20 worked, regardless of category.
Rows for pay periods 2 to 26, from 1/3 - 1/16 to 12/5 - 12/18, then pay period 1, 12/19 - 1/1. Each row has 14 day boxes, Sunday to Saturday twice.
Each section has a carryover box, leave hours and work hours, and per pay period columns for total hours worked, hours applied to leave earned, balance of hours worked, earned and used this pay period, used to date and balance.
Address, last name, first name and middle initial, leave category code, block number, telephone number, service computation date, and the entered on or transmittal date. A tour of duty box sits at the top right.
Untitled columns for each pay period. The form lists examples such as Shared (Donated), Restored, Award, Family Friendly, Military, Compensatory Leave and Credit Hours, plus premium pay such as Night Differential and Overtime.
Enter the employee's name, address and telephone number, the leave category code, block number, service computation date and the entered on or transmittal date. The tour of duty box is at the top right.
Each of the annual leave and sick leave sections starts with a carryover box for the balance brought into the year.
Use the suggested codes in the legend for the day boxes of each pay period. Holidays are already marked H on the 2021 grid.
Record total hours worked, hours applied to leave earned, balance of hours worked, leave earned and used this pay period, used to date and balance. For leave categories 4, 6 and 8 the form prints annual leave earned per pay period of 1 hour per 20, 13 and 10 hours worked. For sick leave it says 1 hour is earned for each 20 worked, regardless of category.
The form says the untitled columns on the back may be used to keep usage and balances for any leave and premium pay categories that apply to the employee.
The form says the Earnings and Leave Statement, the Supervisor's Time and Attendance Report and the Premium Pay Report should agree with the data on this form.
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 and no signature line. It describes itself as an optional form for timekeepers and a record of what SHOULD BE recorded into the official payroll system.
This edition covers 2021: pay period 2 starts 1/3 - 1/16, pay period 26 ends 12/5 - 12/18, and pay period 1 is 12/19 - 1/1.
The front is marked Sensitive, but Unclassified and says PREVIOUS EDITION IS NOT USABLE.
GSA's page for this form lists ADM 5440.708 as its authority or regulation and 06/2021 as the current revision date. The PDF itself prints no OMB number, Privacy Act statement or burden estimate.
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The note on the back of the form says who it is for and how it relates to the payroll system.
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The form prints GENERAL SERVICES ADMINISTRATION at the bottom left and the footer GSA 873A (REV. 6/2021). GSA hosts it in its forms library.
The form says it is an optional form for timekeepers to use in recording daily and bi-weekly pay and leave activity. Each copy records one part-time employee, named in the employee block.
For leave categories 4, 6 and 8 the form prints annual leave earned per pay period of 1 hour per 20, 13 and 10 hours worked. For sick leave it says 1 hour is earned for each 20 worked, regardless of category.
The legend lists H for a holiday and the suggested codes A for Annual Leave, S for Sick Leave, E for Excused, W for Absent Without Leave, M for Military Leave, R for Restored Leave, D for Award Leave, L for Leave Without Pay, CE for Compensation Time Earned, CU for Compensation Time Used, OT for Overtime and C for Continuation of Pay for Traumatic, as printed.
No. The form says it is a record of what SHOULD BE recorded into the official payroll system, while the Earnings and Leave Statement, the Supervisor's Time and Attendance Report and the Premium Pay Report reflect what IS in it. Those reports should agree with the form.
Pay periods 2 to 26 run from 1/3 - 1/16 to 12/5 - 12/18, and pay period 1 is listed last as 12/19 - 1/1.
The front of the form says PREVIOUS EDITION IS NOT USABLE. This edition is Rev. 6/2021, printed in the footer as GSA 873A (REV. 6/2021).