Items 1 to 6: employee and service
Name, Social Security number, agency use box, date and nature of separation, whether the employee is subject to 5 U.S.C. 6304(B) (45 day leave ceiling), and total service for leave as more or less than 15 years.
SF1150
Record of Leave Data
- Agency
- GSA
- Revision
- Rev. 12/1977
- Fillable fields
- 134
- Pages
- 1
- Official source
- GSA form page
- Checked
- October 20, 2026
Standard Form 1150 (SF 1150): Record of Leave Data
Standard Form 1150 (SF 1150), Record of Leave Data, is a one-page leave summary printed as a Civil Service Commission form, Rev. 12/1977, under FPM Supp. 296-31 and 990-2. GSA hosts a copy in its forms library, and GSA's page lists Federal Personnel Manual Supplements 296-31 and 990-2 as its authority.
The form's 27 numbered items are tied to a separation: item 4 asks for the date and nature of separation, and several items report leave as of the date of separation. It summarizes annual and sick leave, lump sum leave, absence without pay, home leave and military leave, and ends with a Certified Correct By signature.
The PDF prints no instructions, OMB number or Privacy Act statement. You can fill it out free in your browser on this page and download the result without an account.
What's on SF 1150
Items 7 to 14: annual and sick leave
Hours of annual, sick and restored leave: carryover balance, current year accrual, total, reductions, leave taken through separation, balance, hours paid in lump sum and salary rate per hour.
Item 15: lump sum leave dates
From and thru dates and hours for restored leave, annual leave above ceiling and annual leave within ceiling.
Items 16 and 17: absence without pay
Hours of absence without pay in the leave year of separation, the date of the last equivalent increase, and LWOP hours since then, except during military service and while in receipt of OWCP payments.
Items 18 to 23: home and military leave
Basic service period abroad, current 12 months accrual period, home leave balance and accrual in days, dates of leave used in the prior 24 months, and military leave in the current calendar year.
Items 24 to 27: remarks and certification
Remarks, including shore leave information if applicable, then the Certified Correct By signature, title, agency, address, telephone number and date.
The 27 items fall into these groups.
How SF 1150 is completed
- 1
Identify the employee and separation
Fill in items 1 to 6, including the 45 day leave ceiling answer and total service for leave as of the date of separation.
- 2
Summarize annual and sick leave
Enter hours in items 7 to 14. Item 8 says to explain in remarks if a 90 day restriction applies, and item 13 has a blank for hours for holidays.
- 3
Record lump sum leave dates
Enter the from and thru dates in item 15. The form says to explain a part-time tour in remarks.
- 4
Add absence, home and military leave
Complete items 16 to 23 where they apply, with dates as month, day and year.
- 5
Add remarks and certify
Use item 24 for remarks, then sign item 25 and complete the title, agency, address, telephone number and date in items 26 and 27.
The PDF has no instructions page, so these steps follow the order of the printed items.
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Authority and what the form says
Where it goes
The PDF gives no filing address or routing instructions.
Authority printed on the form
The footer reads Standard Form 1150 (Rev. 12-77), Civil Service Commission, FPM Supp. 296-31 and 990-2. GSA's page lists Federal Personnel Manual Supplements 296-31 and 990-2.
Leave ceiling
Item 5 asks whether the employee is subject to 5 U.S.C. 6304(B) (45 day leave ceiling), the last date subject to it, and the annual leave balance in hours as of that date.
Privacy and burden
The PDF prints no OMB number, burden estimate or Privacy Act statement, though item 2 asks for a Social Security number.
Related forms
Who is named on SF 1150?
The form prints no instructions and does not say who fills it in. Its items name these people and offices.
Official sources and the blank
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Questions about Form SF1150
Who issues SF 1150?
The footer prints Civil Service Commission and FPM Supp. 296-31 and 990-2, with the edition Rev. 12-77 (December 1977). GSA hosts a copy in its forms library.
When is SF 1150 used?
The form does not say in words. Its items are tied to a separation: item 4 asks for the date and nature of separation, and items 6, 11 and 21 report leave as of the date of separation.
What kinds of leave does SF 1150 cover?
Annual, sick and restored leave, lump sum leave, absence without pay, home leave and military leave, with remarks for shore leave if applicable.
Who signs SF 1150?
Item 25 is a Certified Correct By signature. Item 26 asks for the signer's title, agency, address and telephone number.
What does item 5 ask?
Whether the employee is subject to 5 U.S.C. 6304(B) (45 day leave ceiling), the last date subject to it, and the annual leave balance in hours as of that date.