Standart Form 182 - Authorization, Agreement And Certification Of Training printable pdf download

B. Request Status (Mark (X) one)

A. Agency, code agency subelement

AUTHORIZATION, AGREEMENT

and submitting office number

Resubmission

Initial

AND CERTIFICATION OF TRAINING

Correction

Cancellation

Section A - TRAINEE INFORMATION

Please read instructions on page 6 before completing this form

1. Applicant's Name (Last, First, Middle Initial)

2.Social Security Number/Federal Employee Number

3. Date of Birth (yyyy-mm-dd)

6. Position Level (Mark (X) one)

4. Home Address (Number, Street, City, State, ZIP Code) (Optional)

Home Telephone (Optional)

(Include Area Code)

a. Non-supervisory

b. Manager

c. Supervisory

d. Executive

7. Organization Mailing Address (Branch-Division/Office/Bureau/Agency))

OfficeTelephone

9. Work Email Address

(Include Area Code and Extension)

11. Does applicant need special

10. Position Title

If yes, please describe below

accomodation?

Yes

12. Type of Appointment

14. Pay Plan

15. Series

16. Grade

17. Step

13.

Education Level

(click link to view codes or go to page 7)

Section B - TRAINING COURSE DATA

1b. Location of Training Site (if same, mark box)

1a. Name and Mailing Address of Training Vendor (No., Street, City, State, ZIP Code)

Federal Contractor: ProFeds LLC

DUNS# 962052275; CAGE# 5YRG2

1c. Vendor Telephone Number

1d. Vendor Email Address

PO Box 124, Fox Lake, IL 60020

844-776-3337

2a. Course Title

2b. Course Number Code

3. Training Start Date

4. Training End Date (Enter Date as yyyy-mm-d

(Enter Date as yyyy-mm-dd)

ProFeds' FedImpact Retirement

CSRS/FERS

Workshop

Training Purpose Type

5. Training Duty Hours

6. Training Non-Duty Hours

Training Type Code

(Click link to view codes or go to page 9)

Training Sub Type Code

10.

Training Delivery Type Code

11.

Training Designation Type Code

13.

Training Credit Type Code

12. Training Credit

(Click link to view codes or go to page 9)

(Click link to view codes or go to page 12)

(Click link to view codes or go to page 13)

14. Training Accreditation Indicator

15. Continued Service Agreement

16. Continued Service Agreement Expiration Date

17.

Training Source Type Code

(

Required Indicator

Check below)

(Check below)

(Enter date as yyyy-mm-dd)

(Click link to view codes or go to page 13)

Yes

N/A

18. Training Objective

19. AGENCY USE ONLY

Provide employees with the proper knowledge of federal benefits to be

Employee: Complete blocks 3-6

prepared to retire from federal service.

Agency: Complete blocks 11-16

Section C - COSTS AND BILLING INFORMATION

1. Direct Costs and Appropriation / Fund Chargeable

2. Indirect Costs and Appropriation / Fund Chargeable

Appropriation Fund

Item

Amount

Item

0.00

a. Tuition and Fees

a. Travel

0.00

b. Books & Material Costs

b. Per Diem

c. TOTAL

6. BILLING INSTRUCTIONS (Furnish invoice to):

3. Total Training Non-Government Contribution Cost

4. Document / Purchasing Order / Requisition Number

5. 8 - Digit Station Symbol (Example - 12-34-5678)

U.S. Office of Personnel Management

Standard Form 182

Page 1

Revised December 2006

NSN 7540-01-008-3901

All previous editions not usable.

Standart Form 182 - Authorization, Agreement And Certification Of Training

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