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Name: Employee # Division: Employee Signature: Date: Verified by Payroll: Date: Division Manager's Approval: Date: Department Director's Approval: Date: Department of Management Services Human Resources Section 4-3-H Ogden City Personnel Policies & Procedures Manual: PAY DATE BUY BACK SHOULD PROCESS: *(must be to HR before noon on the Tuesday before pay day)* * Utah Retirement Systems: Vacation Buy-Back Authorization Form Requested Amount : Remaining Vacation Balance: Payouts will occur with the regularly scheduled pay days. ARE YOU PLANNING TO CHANGE YOUR TAXES WITH THIS BUY BACK: WOULD YOU LIKE HOURS SOLD TO GO TOWARDS YOUR H.S.A: OF HOURS TO HSA An employee may request to have the city buy back vacation time twice per fiscal year (July 1 - June 30) as long as the employee maintains a minimum of 40 hours of accrued vacation time remaining after any buy back. For firefighter, the buy back time frame is based on the fire department vacation planning year (March 1- February 28). Firefighters must maintain a minimum of 56 hours accrued vacation time remaining after any buy back. Eligible Employees requesting one or two vacation buy backs with in a fiscal year( fire department vacation planning year for firefighters) are expected to use a min. of 40 hours of vacation time (56 hours for firefighters) in that fiscal year. Any exeptions must be approved by the CAO. The vacation time will be paid out at straight time based on the employee’s rate of pay at the time of the buy back. The employee shall submit a written request for vacation buy back to the employee’s department director for approval and then to the human resources division for processing. Employees who participate in the Public Employees Retirement Systems: Compensation does not include cashout of vacation leave in excess of the amount an employee would normally accrue in that year. Accumulated leave paid upon termination does not qualify as compensation. Employees who participate in the Public Safety or Firefighters' Retirement Systems: Compensation does not include cashout of any vacation leave nor does it include accumulated leave paid. upon termination. lump-sum payments or special payment covering accumulated leave.