Office of Children & Family Services

OCFS-0351(Rev. 01/03)

State of New York

Office of Children & Family Services

ACCRUAL USAGE REQUEST

TO: / DATE:
Name of Supervisor
FROM:
Name of Employee
I hereby request time off to be utilized as follows:
DATE(S) / TIME / HOURS
In (¼ hr units)
Annual Leave
Personal Leave
Sick Leave
Holiday Leave
Non-Comp Overtime
Other Leave
COMMENTS: (Explain “Other Leave” or state reason for request, go to second page for codes.)
APPROVED / DISAPPROVED
REASON FOR DISAPPROVAL:
Workload Consideration
Request is Untimely
Insufficient Staff Available
Other - Explain Below
Signature of Employee / Date
Signature of Supervisor / Date
INSTRUCTIONS: This form must be used when requesting leave.DISTRIBUTION: Employee should save a copy of the request until returned by supervisor

LEAVE CODES

CODE

/

ABBREVIATION MEANING

ALT / Authorized Lost Time (absence with no leave credits remaining)
COT / Comp OT (M/C Only)
DS / Disciplinary Suspension Without Pay
ED / Emergency Duty (excused late arrival as authorized by a collective bargaining agreement)
EL / Educational Leave
EOL / Employee Organizational Leave
ET / Excused Time by the Agency
EX / Civil Service Department and Professional Examinations
FH / Floating Holiday (can be used in one-quarter hour increments – must be used in the year of earning it)
FM / Family Medical Leave Act (FMLA) MUST ALSO BE SHOWN IN ACCRUAL SUMMARY. If employee is eligible, charges are made against a yearly allotment of 12 weeks credited on January 1 each year. This leave can be used intermittently or continuously and may be used concurrently with other accruals.
HL / Holiday Leave (charged to Holiday Accruals)
IDF / Illness or Death in Family (not to exceed 15 days of sick leave)
JD / Jury Duty (attach a copy of the Jury Duty notice)
MAT / Maternity and Child Rearing Leave
ML / Military Leave (must also be shown in the ACCRUAL SUMMARY). Charges are made against an allotment credited on January 1 each year and may not exceed 30 calendar or 22 workdays, whichever is greater in a calendar year. Keep a dual record of the charges in the columns provided in the ACCRUAL SUMMARY Section to determine the method most beneficial to the employee. Attach a copy of your military orders and verification of participation.
PL / Professional Leave (PS&T and M/C staff)
SLH / Sick Leave With Half Pay
SLO / Sick Leave Without Pay
TEA / Tardiness Excused by Agency
UA / Unscheduled Absence
ULT / Unauthorized Lost Time
VR / Voluntary Reduction in Work Schedule
WC / Workers’ Compensation Leave