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Get USAID JF-66 2000-2022

Additional sheets may be used NOMINATED BY Name Title Signature DATE mm-dd-yyyy APPROVED BY Supervisor s Name Title Signature Applicable only if nominated by other than supervisor JF-66 06-2000 PART II - ACTION TAKEN/TIME OFF FROM DUTY AWARD - Optional - For period not to exceed one work day. FOR OFFICE USE DATE REC D BY AWARDS OFFICE STATE DATE RELEASED TO PERSONNEL RECORDS USAID STATE USAID Nomination for Award PART I - NOMINATION NAME OF NOMINEE Last First Middle SOCIAL SECURITY NO. PRESENT POSITION TITLE AND GRADE Position held during period covered by nomination if different than present PERFORMANCE CUSTOMER SERVICE SPECIAL ACT INNOVATION ORG* SYMBOL OR POST REASON FOR AWARD TEAMWORK OTHER CRISIS MANAGEMENT TYPE AWARD RECOMMENDED THE SECRETARY S AWARD SUPERIOR HONOR AWARD TIME OFF FROM DUTY AWARD AWARD FOR HEROISM MERITORIOUS HONOR AWARD CASH SECRETARY S CAREER ACHEIVEMENT AWARD FRANKLIN AWARD DISTINGUISHED HONOR AWARD FOREIGN SERVICE AWARD FOR PUBLIC SERVICE RECOMMENDED AMOUNT Cash/Time Off Hours APPROVED AMOUNT APPROVED AWARD JUSTIFICATION FOR AWARD Include a concise citation to be used on the award certificate. BUREAU/POST APPROVAL Name Title Signature Date MM-DD-YYYY Approve Disapprove REMARKS CASH AWARDS ONLY - APPROVED AMOUNT TYPED NAME OF COMMITTEE CHAIRPERSON SIGNATURE OF COMMITTEE CHAIRPERSON TYPED NAME OF CHIEF OF MISSION SIGNATURE OF CHIEF OF MISSION CERTIFICATION All Committee members reviewing this nomination have attended Diversity Awareness Training for awards committee members. TYPED NAME AND TITLE SIGNATURE PART VII - FISCAL DATA ACCOUNTING CLASSIFICATION Completed by Bureau/Post Budget Officer Agency Appropriation Allotment Obligation No* Org* Code Function Object Award Amount PART VIII - PAYROLL OFFICE INFORMATION - For Gift Cheque Use Only PAYROLL INFORMATION Completed by FMP Gross Amount Federal Tax Withheld Page 2 State Tax Withheld OASDI Tax Withheld FOR GIFT CHEQUE USE ONLY Obligation Net FHI Tax Withheld Net Amount. FOR OFFICE USE DATE REC D BY AWARDS OFFICE STATE DATE RELEASED TO PERSONNEL RECORDS USAID STATE USAID Nomination for Award PART I - NOMINATION NAME OF NOMINEE Last First Middle SOCIAL SECURITY NO. PRESENT POSITION TITLE AND GRADE Position held during period covered by nomination if different than present PERFORMANCE CUSTOMER SERVICE SPECIAL ACT INNOVATION ORG* SYMBOL OR POST REASON FOR AWARD TEAMWORK OTHER CRISIS MANAGEMENT TYPE AWARD RECOMMENDED THE SECRETARY S AWARD SUPERIOR HONOR AWARD TIME OFF FROM DUTY AWARD AWARD FOR HEROISM MERITORIOUS HONOR AWARD CASH SECRETARY S CAREER ACHEIVEMENT AWARD FRANKLIN AWARD DISTINGUISHED HONOR AWARD FOREIGN SERVICE AWARD FOR PUBLIC SERVICE RECOMMENDED AMOUNT Cash/Time Off Hours APPROVED AMOUNT APPROVED AWARD JUSTIFICATION FOR AWARD Include a concise citation to be used on the award certificate. BUREAU/POST APPROVAL Name Title Signature Date MM-DD-YYYY Approve Disapprove REMARKS CASH AWARDS ONLY - APPROVED AMOUNT TYPED NAME OF COMMITTEE CHAIRPERSON SIGNATURE OF COMMITTEE CHAIRPERSON TYPED NAME OF CHIEF OF MISSION SIGNATURE OF CHIEF OF MISSION CERTIFICATION All Committee members reviewing this nomination have attended Diversity Awareness Training for awards committee members. TYPED NAME AND TITLE SIGNATURE PART VII - FISCAL DATA ACCOUNTING CLASSIFICATION Completed by Bureau/Post Budget Officer Agency Appropriation Allotment Obligation No* Org* Code Function Object Award Amount PART VIII - PAYROLL OFFICE INFORMATION - For Gift Cheque Use Only PAYROLL INFORMATION Completed by FMP Gross Amount Federal Tax Withheld Page 2 State Tax Withheld OASDI Tax Withheld FOR GIFT CHEQUE USE ONLY Obligation Net FHI Tax Withheld Net Amount. .

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