U.S. DOD Form dod-va-5638
1. STATION NO.
2. SOCIAL SECURITY NO.
(2-4)
(5-13)
3. NAME
4. DAY NO.
(14-16)
CODE
(17-19)
EMPLOY
PAY ADJUSTMENT AND CASH PAYMENT CODE SHEET
5.
TRANS.
TYPE
6. BASE PAY
7. NIGHT
DIFFERENTIAL
8. OVERTIME
9. HOURS
10. HOLIDAY
11. STANDBY
PREMIUM PAY
(Excluding SES Awards)
(20-21)
(22-27)
(28-32)
(33-37)
(38-40)
(41-45)
(46-50)
(51-56)
12. AWARD
15
14. UNIF. LIVING ALLOW.
SUN. ON CALL
13. LUMP SUM
CODE
(63)
(57-62)
AMOUNT
(64-68)
APPR
(6
82
92
R2
82
92
R2
82
92
R2
16.
TRANS.
TYPE
(20-21)
17. OASDI/MEDICARE
18. RETIREMENT/LIFE INSURANCE/HEALTH BENEFITS
19. Q/S/G
20. FED. STATE TAX
21. PRIOR PAYMENT
CODE
AMOUNT
CODE
EMPLOYEE SHARE
VA SHARE
INS. CODE
CODE
AMOUNT
CODE
AMOUNT
CODE
(22)
(23-27)
(28)
(29-33)
(34-38)
(39-41)
(42)
(43-47)
(48)
(49-53)
(54)
22.
OTHER
DEDUCTION
(61-66)
AMOUNT
(55-60)
83
93
R3
83
93
R3
83
93
R3
83
93
R3
83
93
R3
25.
TRANS.
TYPE
(20-21)
26. RESERVED
RES
(22)
27. UNION
RESERVED
(23-27)
CODE
(28-31)
AMOUNT
(32-34)
28. VOLUN. CONTRIBUTIONS
CODE
(35-37)
AMOUNT
(38-42)
28A.
RES.
(43-44)
28B.
CALENDAR
YEAR
ADJUSTMENT
(45-47)
29. CITY TAX
GSA CODE
(48-53)
AMOUNT
(54-59)
30. APPROPRIATION
CODE
(60-64)
31. FOR DPC USE ON
RES
(65-66)
GSA CODE
(67-72)
84
94
R4
84
94
R4
33.
TRANS.
TYPE
(20-21)
34. DISBURSING
AUTHORITY
APPROP. CODE
(22-26)
35.
RET.
CODE
(27)
36.
TSP
STATUS
(28)
37. TSP BASE PAY
ADJUSTMENT AMOUNT
(29-35)
38.
PERCENT
RATE
(36-38)
39.
DOLLAR
AMOUNT
(39-42)
40.
SUS-
41.
TAX
PENSE CODE
(43) (44)
42. DIST. OF EMPLOYEE DEDUCTION
GS
(45-47)
FI
(48-50)
CS
(51-53)
86
96
R6
86
96
R6
86
96
R6
44. SEPARATE AWARD CHECK
INCENTIVE
(22-28)
SES
(29-35)
89
REMARKS (If additional space is required, use reverse.)
46.
TRANS.
TYPE
(20-21)
47. NAME
(22-43)
R1
VA FORM
DEC 1992
43.
TRANS.
TYPE
(20-21)
5638
48.
NORMAL
HOURS
(44-45)
49.
PAY
BASIS
(46)
50.
DUTY
BASIS
(47)
51. COST CENTER
(48-53)
52.
SUBACCT.
(54-55)
53.
FTE
EQUIV.
(56)
54.
SEPAR.
DAY NO.
(57-59)
55.
Q&S
STATION NO.
(60-63)
56.
57. DA
FUND
CONTROL
MONTH
POINT NO.
(67-68)
(64-66)
REMARKS (If additional space is required, use reverse.)
RES
(65-66)
SES
(29-35)
MONTH
(67-68)
DAY
(69-70)
CODE
(80)
YEAR
(71-72)
DATE
58.
TAX
YEAR
(73)
60.
PAY
61.
TYPE
(74) (75) (76)
ONLY PLAN APPT
59.
DPC
AUTHORIZED BY
CODED BY
APPROP. CODE
(69-73)
64..
REC.
REQ.
DPC
(80)
DATE
62.
63.
RES. HBS
CODE CD
(77-78) (79)
VERIFIED
BY
AMOUNT
(74-80)
45. DISBURSING AUTHORITY FOR THIS
ADJUSTMENT ONLY
GROSS PAY AMOUNT
(73-79)
32. WAGE ADJUSTMENT
AMOUNT
(74-80)
24. DISBURSING AUTHOR. FOR THIS
ADJUSTMENT ONLY
AMOUNT
(74-80)
APPROP. CODE
(69-73)
57. DATE OF BIRTH
GSA CODE
(67-72)
31. FOR DPC USE ONLY
23.
STATE
GSA
CODE
(67-68)
APPROP. CODE
(69-73)
15. DISBURSING AUTHOR. FOR THIS
ADJUSTMENT ONLY
EMPLOYEE’S NAME