Fillable Form OPM 71 (2017)

What is Form OPM 71?

Form OPM 71 or officially Request for Leave or Approved Absence is a document that the U.S. Office of Personnel Management (OPM) issues for government employees to complete and file to request time off.

Government employees must request leave using Form OPM 71 as soon as possible to increase the chances of approval by their supervisors. Supervisors will use it to approve or reject the request of employees for time off.

The types of leaves that require government employees to file Form OPM 71 include Accrued Annual Leave, Advanced Annual Leave, Restored Annual Leave, Advanced Sick Leave, Accrued Sick Leave, Compensatory Time Off, Other Paid Absence, Leave Without Pay, and Family and Medical Leave.

How to Fill Out Form OPM 71?

Form OPM 71 is a single-page, straightforward document. It requires information related to a leave of absence. To avoid unnecessary delays and get positive feedback on the application, make sure to fill the form accurately and honestly. Do not falsify the information you will provide, as doing so can result in penalties or worse, removal from service.

Form OPM 71 consists of several parts. Be mindful of answering every item to avoid errors.

There would be instances when you will need to provide additional documents, such as a medical document or certificate. Prepare the required additional documents to support your request.

1. Name
Provide your full legal name in the following format: Last, First, Middle.

2. Employee or Social Security Number
Provide your employee number or the last four digits of your Social Security Number.

3. Organization
Provide the name of the government organization where you are working.

4. Type of Leave or Absence
Mark the appropriate checkbox to determine the type of Leave or Absence that you are taking. You may select Accrued Annual Leave, Restored Annual Leave, Advanced Annual Leave, Accrued Sick Leave, Advanced Sick Leave, Compensatory Time Off, Other Paid Absence, or Leave Without Pay.

Provide the dates and time when you intend to start and end your leave. Also, compute for the amount of total hours of time off.

For Accrued Sick Leave and Advanced Sick Leave, mark the appropriate checkbox to determine the purpose of your leave. You may select illness, injury, or incapacitation of the requesting employee; medical, dental, or optical examination of the requesting employee; care of a family member, including medical, dental, or optical examination of a family member, or bereavement; care of a family member with a serious health condition; or other.

5. Family and Medical Leave
If you are filing a leave under the Family and Medical Leave Act of 1993, you can invoke your entitlement to Family and Medical Leave for the following reasons: birth, adoption, or foster care; serious health condition of a spouse, son, daughter, or parent; or serious health condition of self. Mark the appropriate checkbox.

6. Remarks
You may use this section to write any additional information. For instance, if you select Other Paid Absence in Item 5, provide the specifications in this section.

7. Certification
This section contains a certification statement. By signing Form OPM 71, the requestor certifies that the time off will only be used according to the purposes provided in the application and complies with the procedures and will provide additional information if required. The requestor also agrees that falsification may result in appropriate disciplinary actions or removal.

7a. Employee Signature
If you agree with the statement in Item 7, provide your signature in this section.

7b. Date
Provide the date when you signed Form OPM 71.

8a. Official Action of Request
Your supervisor will use this section to determine if the request is Approved or Disapproved by marking the appropriate checkbox.

8b. Reason for Disapproval
If the request is disapproved, your supervisor will indicate in this section the reason for the disapproval.

8c. Supervisor Signature
Your supervisor must sign in this item to validate his or her decision.

8d. Date
Your supervisor should provide the date when he or she signed Form OPM 71.