<p> DEFENSE FINANCE AND ACCOUNTING SERVICE Civilian Pay Operations</p><p>1. BACK PAY CHECKLIST</p><p>DFAS requires the following documentation be submitted with a request for the payment of back pay pursuant to an agency or court order, settlement agreement, agency determination or arbitrator award. Please use the following checklist to ensure your request is complete. Missing documentation may substantially delay the processing of a back pay award. </p><p>☐ 1) Submit “SETTLEMENT INQUIRY - Submission” Remedy Ticket. Please identify the specific dates of the back pay period. </p><p>Attach the following documentation to the Remedy Ticket, or provide a statement as to why the documentation is not applicable: ☐ 2) Settlement agreement, administrative determination, arbitrator award, or order.</p><p>☐ 3) Signed and Completed “Employee Statement Relative to Back Pay” (see attached).</p><p>☐ 4) All required SF50s (new, corrected, or canceled). ***Do not process online SF50s until notified to do so by the payroll office.***</p><p>☐ 5) Certified timecards/corrected timecards. ***Do not process online timecards until notified to do so by the payroll office.***</p><p>☐ 6) All relevant benefit election forms pursuant to 5 CFR 550.805 (i.e. for FEGLI, FEHB, TSP, etc.).</p><p>☐ 7) Outside earnings documentation. Include record of all amounts earned by the employee in a job undertaken to replace lost wages during the back pay period. Documentation includes W-2 or 1099 statements, payroll documents/records (for current year, unless requested otherwise), unemployment earning statements, workers’ compensation, etc. Include record of any retirement annuity payments, retirement refunds or severance pay received by the employee upon separation.</p><p>☐ 8) The type of leave to be charged if the employee was unable to work during any part of the back pay period. Provide corrected timecards for leave charged.</p><p>☐ 9) If the back pay period includes dates prior to the agency’s conversion to DCPS, include a statement/spreadsheet certifying the breakdown of the amount owed prior to conversion that identifies all pay and leave affected. ☐ 10) Statement regarding whether interest is payable and the beginning date of accrual.</p><p>Lump Sum Payment Debts: When a separation is later reversed, there is no authority under 5 U.S.C. 5551 for the reinstated employee to keep the lump sum leave payment he or she may have received. The payroll office must collect the debt from the back pay award. The annual leave will be restored to the employee. Annual leave that exceeds the annual leave ceiling will be restored to a separate leave account pursuant to 5 CFR 550.805.</p><p>Questions: If you have questions or need to submit additional information, please use the “SETTLEMENT INQUIRY - Follow-up” Remedy ticket.</p>