Overtime Pay Request Authorization Form

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Print Form UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT Form 1400-64 (550) (February 1978) OVERTIME/HOLIDAY PAY REQUEST AND AUTHORIZATION To: NAME OF EMPLOYEE PAY PLAN AND GRADE GS, WG DATES FROM THROUGH TOTAL HOURS WORKED OVERTIME/ HOLIDAY COMPENSATORY TIME FOR OVERTIME ELECTS ADMINISTRATIVELY REQUIRED Justification (give description of work and reason for overtime) Requested by (signature) Title Date Title Date Organization Approved Disapproved Exclude meal periods Employee must initial Authorized Officer must initial Authorized Officer s signature (Instructions on reverse) INSTRUCTIONS Completed form is returned to requesting officer who will forward approved form to timekeeper for retention with timekeeping records..

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