OPM Form 71 PDF Details

The form OPM 71 includes various sections for the employee to provide their personal information, type of leave requested, and any relevant details about their request. It also requires the employee to certify the accuracy of the information provided and acknowledge that falsification of the form could lead to disciplinary action.

The form also includes a Privacy Act Statement, which outlines the authorized collection and use of the information provided, as well as potential consequences for failing to furnish a social security number or tax identification number.

Here is some information that might be handy if you're looking to learn how much time it'll take you to complete employee leave request form and what number of PDF pages it contains.

Form NameOPM (SF) Form 71
Form Length1 pages
Fillable fields1
Avg. time to fill out27 sec
Other namesleave request form, opm form, 71 sf, leave forms

Form Preview Example

Request for Leave or Approved Absence

1.Name (Last, first, middle)

2.Employee or Social Security Number (Enter only the last 4 digits of the Social Security Number (SSN))


4. Type of Leave/Absence







5. Family and Medical

(Check appropriate box(es) below)












Accrued Annual Leave









If annual leave, sick leave, or













leave without pay will be used



Restored Annual Leave









under the Family and Medical













Leave Act of 1993, please provide



Advanced Annual Leave









the following information:













I hereby invoke my



Accrued Sick Leave



















entitlement to Family



Advanced Sick Leave









and Medical Leave for:





















Birth/Adoption/Foster Care














Illness/injury/incapacitation of requesting employee









Serious health condition of













Medical/dental/optical examination of requesting employee




spouse, son, daughter, or























Care of family member, including medical/dental/optical examination of family


Serious health condition of




member, or bereavement


































Care of family member with a serious health condition





Contact your supervisor and/or

























your personnel office to obtain













additional information about your



Compensatory Time Off









entitlements and responsibilities













under the Family and Medical















Other Paid Absence



















Leave Act. Medical certification of



(Specify in Remarks)









a serious health condition may be













required by your agency.



Leave Without Pay


































7.Certification: I hereby request leave/approved absence from duty as indicated above and certify that such leave/absence is requested for the purpose(s) indicated. I understand that I must comply with my employing agency's procedures for requesting leave/ approved absence (and provide additional documentation, including medical certification, if required) and that falsification on this form may be grounds for disciplinary action, including removal.

7a. Employee Signature

7b. Date

8a. Official Action on Request:



(If disapproved, give reason. If annual leave,

initiate action to reschedule.)








8b. Reason for Disapproval:




8c. Supervisor Signature

8d. Date


Section 6311 of Title 5, United States Code, authorizes collection of this information. The primary use of this information is by management and your payroll office to approve and record your use of leave. Additional disclosures of the information may be: to the Department of Labor when processing a claim for compensation regarding a job connected injury or illness; to a State unemployment compensation office regarding a claim; to Federal Life Insurance or Health Benefits carriers regarding a claim; to a Federal, State, or local law enforcement agency when your agency becomes aware of a violation or possible violation of civil or criminal law; to a Federal agency when conducting an investigation for employment or security reasons; to the Office of Personnel Management or the General Accounting Office when the information is required for evaluation of leave administration; or the General Services Administration in connection with its responsibilities for records management.

Public Law 104-134 (April 26, 1996) requires that any person doing business with the Federal Government furnish a social security number or tax identification number. This is an amendment to Title 31, Section 7701. Furnishing the social security number, as well as other data, is voluntary, but failure to do so may delay or prevent action on the application. If your agency uses the information furnished on this form for purposes other than those indicated above, it may provide you with an additional statement reflecting those purposes.

Office of Personnel Management

Local Reproduction Authorized

5 CFR 630






Print Form



Save Form








Clear Form

OPM Form 71

Rev. September 2009

Formerly Standard Form (SF) 71

Previous editions usable

How to Edit OPM (SF) Form 71 Online for Free

The PDF editor makes it simple to fill out the opm form file. You will be able to make the form easily through these simple steps.

Step 1: First, choose the orange "Get form now" button.

Step 2: Once you have accessed the opm form edit page, you will notice all actions it is possible to take regarding your document at the top menu.

Fill in the opm form PDF by providing the content meant for every single part.

part 1 to writing sf71

Write down the essential particulars in Other, Compensatory Time Off, Other Paid Absence Specify in, Leave Without Pay, Remarks, Contact your supervisor andor your, Certification I hereby request, a Employee Signature, b Date, a Official Action on Request, Approved, Disapproved, If disapproved give reason If, b Reason for Disapproval, and c Supervisor Signature segment.

Completing sf71 stage 2

Write down any data you are required within the segment Office of Personnel Management, Local Reproduction Authorized, and OPM Form Rev September Formerly.

stage 3 to filling out sf71

Step 3: Select "Done". Now you may export your PDF document.

Step 4: Get a duplicate of every single document. It may save you some time and allow you to stay clear of complications as time goes on. Also, your information will not be shared or viewed by us.

Watch OPM (SF) Form 71 Video Instruction

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