PerFORM PRO FORM 1.01+. N/ $Agency . NameEmpl . SSNcy . PosTitle . OrgLocat . ToeEmpl . PayPlan . AcctCode . Address . SalAddr  =!~= ?? OtherAdd  +$+ /1.1 ListAwar . Citation . EmpSugg =!= >> ExtraEff /H".H 'H&H SpotAwar H"H 1~1 TimeOff /#".# // OtherAwa /"/  PerBonAw _!^  NoPerson . TotAwardK. MeaBenSc __ NN NonMeaBe KK 'L&L EstSaveC. ValueBenK.  X!!Value of Benefits: Small Moderate Substantial ExtendedApplicaK.  LApplication: Broad Limited GeneralKeepsake G("F( 88 QualStep 'E$&E EE LastProm . LastWith . AmtRecomC . RecTitle !. RevTitle ". Frommpl . Gainshar o/$n/ _/^/ ApTitle #. ?/>/ 0GGType Approving Official's title in this space.$Courier1Univers (WN)"CG Times (WN)Univers ATT"Times New RomanModern2""#"Va $ 1H58:'WX EJ=E=7. PERIOD COVERED FOR AWARD (mm,dd,yy)  From:  a(3HTap&1 EP@ E@U.S. DEPARTMENT OF AGRICULTURE  RECOMMENDATION & APPROVAL OF AWARDSH3"T'p1 E2@ E@CASE NO. (Personnel Use Only) HC3HS&o&X(]udX EAEA* Attach a description of the contribution or patent notification being recognized and the resulting benefits to the Government.j'V!d_1XoEAnEANOTE: For group awards, attach list of group members. Show data in items 2 - 9, and award amount for each payee.(d1"b81X   Agency gEB fEB1. AGENCY 1dm""81X  NameEmpl WEJA VEA2. NAME OF EMPLOYEE (Last, first, middle initial) ("1b8:1X   SSNcy GE%A FEA3. SOCIAL SECURITY NO. 1"H8':1X   PosTitle F _B F^B4. POSITION TITLE (1b:8s1X   OrgLocat F+C FC6. ORGANIZATION AND LOCATION H"a'91X  PayPlan F7; F;5. PAY PLAN- SERIES / GRADE / STEP Ha"'9s1X  AcctCode wF'/C vF.C8. ACCOUNTING CODE (,@bs/X _F8; ^F;9. IF AWARD APPROVED, MAIL CHECK TO: ( /!;bD1X  ListAwar GFB FFB10. LIST AWARDS OR QSI'S IN THE PAST 52 WEEKS (Specify type of award, amount received, and effective date.) 1A# 8s1X  Address E< E< (ADDRESS) 11x8s8XWf*1X SalAddr xXZg1X OtherAdd hX ?G)B >GBSALARY CHECK ADDRESS  >j_X =2O; =N;OTHER (Specify address): (;/!bD1X Citation'GB &GB11. CITATION: SUMMARIZE EMPLOYEE'S CONTRIBUTION IN 25 WORDS OR LESS (This language will appear on the employee's certificate.) EMPLOYEE IS BEING RECOGNIZED FOR: j']!Z_1@4wB@vBCOMPLETE THE APPROPRIATE AWARD SECTIONKWX 71J+ 61+12. TYPE OF RECOGNITION RECOMMENDED (Check one) &"^X'Ict_o1X  G+G+EXTRA EFFORT AWARDWf%/1X EmpSugg =jڱHX F6w9 Fv9EMPLOYEE SUGGESTION OR INVENTION *  % /1X ExtraEff ڱ HX F&?H F>HEXTRA EFFORT AWARD C%% /1X SpotAwar aU <X ?G ?GSPOT AWARD !0%/1X TimeOff t3ڱ8X F(O FOTIME OFF AWARD ** ** & &/1X OtherAwa  &9X Fw+ Fv+OTHER * WWff0X PerBonAw =jÎYX D(DPERFORMANCE BONUS AWARD * =(Q-`4`@qXg:G f:GIt is the policy of the Department to ensure that consideration for awards is made without regard to race, color, national origin, religion, sex, age, marital status, disability or other nonmerit factors.\+ D0X NonMeaBe nP= k/^XD1DNONMEASURABLE BENEFITS SCALE &/D1X  EstSave 2cX :(: ORIGINAL - Processing Copy{פ?E18 sX  ToeEmpl 'DP &DP  To: 1פ!;684rX  Frommpl :C :~C  From: Kd1X Gainshar Ԩw- OzqX wA%?O vA>OGAINSHARING AWARD lLjfk gAfA $ %<@ WA>VA> $ ( 4lK"'wX /A.ADATE Colo'IXMl'wX ApTitle'A&A CCCCCC3> 2bX A2A 1st Copy- Official Personnel Folder 3> 2bX o;$n; 2nd Copy- Obligation Record_=71aX @ @ 3rd Copy- Employee Copy