Free AO 501 - Federal

OAO 501 (Rev. 3/04)

QUARTERLY REPORT OF CONTINUATION OF PAY
To: ADMINISTRATIVE OFFICE OF THE U. S. COURTS HUMAN RESOURCES DIVISION TRAINING, ANALYSIS, AND BENEFITS ADMINISTRATION BRANCH (TABAB) WASHINGTON, DC 20544 REPORT PERIOD (mm/dd/yyyy) FROM NO EMPLOYEES USED CONTINUATION OF PAY (COP) DURING THIS REPORT PERIOD. THE FOLLOWING DATA IS PROVIDED FOR THOSE EMPLOYEES WHO USED COP DURING THIS REPORT PERIOD. TO

NAME OF COURT:

EMPLOYEE 1
NAME SOCIAL SECURITY NUMBER DATE OF INJURY COP HOURS PAID* DATE COP BEGAN DATE COP ENDED COP DOLLARS PAID COP HOURS PAID IN PREVIOUS QUARTER

EMPLOYEE 2

EMPLOYEE 3

EMPLOYEE 4
NAME SOCIAL SECURITY NUMBER DATE OF INJURY COP HOURS PAID* DATE COP BEGAN DATE COP ENDED COP DOLLARS PAID COP HOURS PAID IN PREVIOUS QUARTER

EMPLOYEE 5

EMPLOYEE 6

EMPLOYEE 7

EMPLOYEE 8

EMPLOYEE 9

NAME SOCIAL SECURITY NUMBER DATE OF INJURY COP HOURS PAID* DATE COP BEGAN DATE COP ENDED COP DOLLARS PAID COP HOURS PAID IN PREVIOUS QUARTER *THIS ENTRY MUST REFLECT COP HOURS PAID. ROUND INCREMENTS OF LESS THAN AN HOUR TO THE NEAREST HOUR. THERE IS A DISTINCTION BETWEEN COP HOURS PAID AND COP DAYS COUNTED TOWARD THE 45 DAY MAXIMUM. FOR EXAMPLE, AN EMPLOYEE MAY HAVE FOUR CALENDAR DAYS CHARGED TO COP (FRIDAY, SATURDAY, SUNDAY AND MONDAY), BUT ONLY BE PAID FOR TWO DAYS (FRIDAY AND MONDAY) BECAUSE THE OTHER TWO DAYS ARE HIS OR HER REGULARLY SCHEDULED DAYS OFF. IN THIS EXAMPLE, YOU WOULD REPORT THAT THE EMPLOYEE WAS PAID 16 HOURS OF COP. IF THIS EMPLOYEE HAD WORKED FOUR HOURS ON FRIDAY AND FOUR HOURS ON MONDAY, YOU WOULD REPORT THAT THE EMPLOYEE WAS PAID EIGHT HOURS OF COP.
PERSON TO CONTACT FOR MORE INFORMATION TELEPHONE NUMBER

SIGNATURE OF CERTIFYING OFFICER

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