The Department of Defense has released a new form, the Da Form 5172 R. This form is used to report radiation exposures for military personnel and their families. The purpose of this form is to provide a standardized way to report all radiation exposures, both intentional and unintentional. The release of this new form underscores the importance of reporting any radiation exposure, no matter how minor it may seem. Personnel who have been exposed to radiation should complete and submit a Da Form 5172 R as soon as possible. Doing so will help ensure that everyone involved is aware of the potential risks and can take appropriate action if necessary.
| Question | Answer |
|---|---|
| Form Name | Da Form 5172 R |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | da 5172, da 5172 form, da5172, 5172 r pdf |
REQUEST, AUTHORIZATION, AND REPORT OF OVERTIME
For use of this form, see AR
PAY PERIOD ENDING DATE DATE PREPARED
THRU (If applicable)
TO (Approving Officer)
FROM (Office or Division, Branch, Section, Unit or Separate Activity)
INSTRUCTIONS
1.A separate request for overtime shall be prepared in an original and two copies for each pay period in which overtime is to be worked. One copy will be retained until the approved/disapproved copy is returned.
2.Enter the name of employees, social security number, grade and step, date work is to be performed, the clock hours of duty, number of overtime hours to be worked by each employee.
3.The requesting official shall sign the request and submit to the appropriate authorizing official. If the authorizing official concurs he/she shall sign the form and return a copy to the requesting office. The original will be forwarded to the Civilian Payroll Office.
Authority is hereby requested for the performance of the overtime described below which is beyond the regularly established
SOCIAL SECURITY
NUMBER
EMPLOYEE NAME
GRADE/
STEP
DATE
WORK
IS TO
BE PER-
FORMED
CLOCK HOURS OF DUTY
NUMBER
OF
HOURS
RE-
QUESTED
METHOD OF
COMPENSATION
Overtime |
Holiday |
*Compen- satory Time |
*NOTE: (Employees occupying wage grade positions may not be granted compensatory time, except for employees working alternate work schedules.) (Compensatory time cannot be granted for holiday work.)
TOTAL HOURS
DA FORM |
EDITION OF APR 83 IS OBSOLETE. |
USAPPC V2.00 |
NATURE OF DUTIES AND JUSTIFICATION FOR OVERTIME (Enter a short description of the work to be performed and the reason why it must be performed by overtime)
TYPED NAME AND TITLE
REQUESTED BY (Signature)
DATE
TYPED NAME AND TITLE
AUTHORIZED BY (Signature)
DATE
REMARKS
REVERSE OF DA FORM |
USAPPC V2.00 |