VA Form 3248 at a glance
What it is: VA Form 3248 is the Without Compensation (WOC) Employee's Clearance from Indebtedness, with Name of WOC Employee, Last Four SSN, Mail Forwarding Address and Today's Date.
Who signs: The form has a SIGNATURE OF EMPLOYEE and a DATE under the WOC Employee Certification: the employee is aware of the criminal penalties for the unlawful removal of Federal records (Title 18, U.S. Code 2071), and does not have any Government Records or property other than which the employee is properly authorized to possess. The form has a SIGNATURE OF APPROVING OFFICIAL (HRMS) and a DATE.
Without Compensation (WOC) employees must clear the Medical Center at the end of their rotation. Clear in the order shown and allow sufficient time for clearing. The name of each clearance official and the date must be entered in the Clearance Official Name, Date field. All information is subject to verification.
What to bring and attach to VA Form 3248
Turn in your PIV card and this completed clearance form.
A filled-in VA Form 3248 example: a WOC employee being separated from VA
How to fill out VA Form 3248, box by box
Name, last four SSN, mail forwarding address, position title and station
Under WITHOUT COMPENSATION (WOC) EMPLOYEE'S CLEARANCE FROM INDEBTEDNESS, enter the Name of WOC Employee, Last Four SSN, Mail Forwarding Address and Today's Date.
Enter the Position Title, Station No. 515, and the Service, Division, Section and Duty Station.
The employee is (Check one) and the effective date
Under THE EMPLOYEE IS (Check one), mark BEING SEPARATED FROM VA or BEING TRANSFERRED TO (Specify).
Under the second THE EMPLOYEE IS (Check one), mark VETERAN or NON VETERAN.
Enter the EFFECTIVE DATE.
Clearance Official Name, Date and Articles Turned In/Comments
Enter the CLEARANCE OFFICIAL NAME, DATE and the ARTICLES TURNED IN/COMMENTS.
Stop 1 is completed by the Service Chief, supervisor, or designee, Stop 2 by the Service ADPAC, Stops 3-4 by the Service Chief, supervisor, or designee, Stop 5 by the Service Level Records Liaison Officer (RLO) and Stops 6-8 by the WOC employee.
The Service Chief, supervisor, or designee must send an e-mail to vhabacclearance@va.gov to provide notification of clearance. Include employee's name, VA e-mail address and date of last day on station. Send on day of clearance, not in advance. Service ADPAC: Submit ePAS request to terminate access.
Have student take the anonymous (smart phone accessible) Learner's Perception Survey at www.va.gov/oaa/surveys.
Turn in items you were issued by your VA preceptor (keys, lab coats, etc.).
Records review, certification and signature
Verify that a review of agency records accessible to or possessed by the employee, including his/her electronic U: drive has been completed and that the agency records have been appropriately secured or transferred. WOC Employee Certification: the employee is aware of the criminal penalties for the unlawful removal of Federal records (Title 18, U.S. Code 2071), and does not have any Government Records or property other than which the employee is properly authorized to possess. The form has a SIGNATURE OF EMPLOYEE and a DATE.
More rules for VA Form 3248
6. Police Service (In Person), Building 27, Ext. 33645: Parking tags/decal, if issued. If not issued, write N/A in Clearance Official Name, Date. 7. Information Technology Operations and Services (ITOPS) (In Person): Digital pagers, laptops, cell phone, etc. Computer access will be terminated.
If your situation is different
You are a Wyoming Healthcare Center or Community Based Outpatient Clinic employee
Wyoming Healthcare Center and Community Based Outpatient Clinic Employees: All clearance stops will be completed by phone.
The Service Chief, Supervisor or designee will make arrangements for returning the employee's keys, equipment, pagers, etc. as directed by the clearance official for each stop.
Common questions about VA Form 3248
Where do I file it?
LAST STOP: Human Resources PIV Office (In Person), Security Assistants, Building 24, Room 121 or 120, Ext. 36780 or 35243.
Sources
[1] VA Form 3248 WOC (03/30/2019), Department of Veterans Affairs (the Official source link on this page).