NASA Headquarters' Directives | |
HQPR 3000.1 Effective Date: May 24, 2016 Expiration Date: May 24, 2021 Responsible Office: LE |
Student Loan Repayment Program Plan |
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Employee Name:
Social Security Number:
Title Series/Grade/Step Type of Appointment:
Total Amount of Student Loan Repayment Benefit Received
to Date (include the requested amount from this
request
form): $__________________
Student Loan Repayment Benefit Amount Requested: $_______________
Student Loan Repayment Benefit for Year Number: (Circle One)
1 2 3 4 5 6 Other ____
NOTE: Attach service agreement to this
request form.
Current Balance of Outstanding Loan: $_________________
NOTE: attach official documentation from
loan holder documenting loan balance, loan account
number and type of loan to this request
form.
Compensation:
Salary Base/Locality Pay $ _______________
Other Continuing Pay, e.g., PSP, retention allowance, etc. $ _______________
Other Payments, e.g., lump sum payments $ _______________
Student Loan Repayment Benefit Amount $ _______________
TOTAL COMPENSATION $ _______________
_____________________________________
Recommending Official Name/ Title
__________________________
Date
_____________________________________
Certification of Funds Official Name/Title
____________________________
Date
_____________________________________
Personnel Official Title
_______________________________
Date
____________________________________
Approving Official Title
_________________________________
Date
____________________________________
Effective Date
_______________________________________
Expiration Date