;
SOFTWARE CHANGE REQUEST
TO BE COMPLETED BY REQUESTING OFFICIAL
(COMPLETE BLOCKS 1 – 14 FOR ALL TYPES OF REQUESTS)
1. DEPARTMENT/AGENCY 2. AGENCY CONTROL /TRACKING NUMBER 3. DATE OF REQUEST
AUTHORIZED REQUESTING OFFICIAL
8. E-MAIL ADDRESS
6. PHONE NUMBER
9. PHONE NUMBER
Note: All requests submitted must go through an initial review. The Functional Requirements Document (FRD) must be created, and if required, an Interagency
Agreement (IA.) Once these steps are completed, and the FRD and IA have been signed and returned to NFC, an implementation pay period will be assigned
by the appropriate development sta. Requests are worked in the order they are received. Priority is given to regulatory changes, mandated changes, and
changes that aect pay.
If PII information is being provided, attach a password protected document. Send password to [email protected] in a separate email.
Provide attachment if additional lines are needed.
11. PROJECT TITLE
12. TYPE OF REQUEST
SUBMIT AN E-MAIL WITH THE COMPLETED FORM ATTACHED TO THE E-MAIL ADDRESS BELOW. COMPLETE SUBJECT LINE AS INDICATED BELOW:
[email protected]
Subject: “Request Project Title” - New SCR
Note: For all inquiries, regarding the status of a request, please enter the following subject line:
Subject: “Project Title” – NFC SCR #
13. Change Description: (Provide supplemental details and/or documentation, e.g., data elements, data ow, edits, input documents/screens requiring changes,
inquiry screen, limitations, NOAC/authorities, other output documents, reports, security, system controls, table element values, and table matrix logic. Provide
attachment if additional lines are needed.)
10. Planned Funding Source Single-Year Multi-Year No-Year
Authority:
14
. Provide information that gives an indication of the importance of this request, including date when request is needed: (Provide attachment if additional lines
are needed.
15. Comments: (Provide attachment if additional lines are needed.)
FORM AD-3003 (REV. 2/23)
CONTACT PERSON
4. NAME/TITLE
5. E-MAIL ADDRESS
7. NAME/TITLE
Accounting
eOPF – Check appropriate form(s)
SF50
SF2809
SF2810
TSP1
TSP1C
SPPS Payments
TMGT – Attach Screen print(s)
401K, Catch-up, Roth Plan Codes
– Complete Section A
New Allowance/Bonus/Award
– Complete Section B
New Flexible Spending Account (FSA)
– Complete Section C
New Pay Plan/Band
– Complete Section D
Position Management System
(PMSO) – Complete Section E
EmpowHR – Complete Section F
All Other Types
FORM AD-3003 (REV. 2/23)
PAGE 2 OF 5
SECTION A – 401K, CATCH-UP, ROTH PLAN CODES
1
. What is the name of plan code? 2. Will the plan be pre-tax or post-tax? 3. Will the plan be subject to contributions?
5. Will the plan be subject to IRS deferral limit?
6. Will the plan have minimum or maximum limits? (If yes, dene limits.)
MINIMUM MAXIMUM
7. Will the plan be tied to any existing plans? (If yes, dene plans.)
8. Will the deductions be a percentage, whole dollar, or both?
9. Will manual processing be allowed to refund deduction amounts to employees that were deducted in error?
PRE-TAX POST-TAX
YES NO YES
NO
YES NO
12. What is the vendor name? (Table 80 info)
10. What is the Routing Number?
11. Account Number
13. Which elds will be included in the payment vendor le layout? (Must include employee name, SSN, deduction amount, and plan code.)
SOCIAL SECURITY NUMBEREMPLOYEE NAME DEDUCTION AMOUNT PLAN CODE
OTHER
14. When is enrollment allowed? (e.g., Enrolled at accession, after probationary period, etc. (Provide attachment if additional lines are needed.)
15. Does employee need to re-enroll each year? 16. Will employee be able to start, stop, or change at any time?
17. What is the eective date for the new 401(k), Catch-up, or Roth plan(s) being implemented?
18. Provide TMGT Table update information. (Provide attachment if additional lines are needed.)
SECTION B – NEW ALLOWANCE/BONUS/AWARD (If approval was required by OPM, provide a copy of the letter from OPM.)
2. What criteria should be used to identify eligible employees?
GRADE SERIES PAY PLAN OTHER
4. Are LWOP or separated employees eligible to receive the allowance or bonus/award?
YES NO
3. How will the allowance or bonus/award be paid?
BIWEEKLY
MONTHLY
YEARLY LUMP SUM
YEARLY SPECIFIC AMOUNT
DEDUCTED
5. Is a new transaction code needed on the T&A?
YES
YES
YES
YES
NO
NO
NO
NO
6. What is the award code? 7. What is the NOA/authority? 8. Should SF-50s be generated?
9. Should the allowance or bonus/award be reported in CPDF? 10. Is the allowance taxable?
FEDERAL STATE FICA
12. If allowance is part of base pay, should it be included in the calculation of:
YES NOTSP? YES NORETIREMENT? YES NOLIFE INSURANCE?
11. Which tax categories apply?
YES NO
YES NO
YES
NO
13. If the allowance/bonus is a yearly amount and needs to be modified during the year, will NFC process a mass data adjustment under a reimbursable
agreement?
YES NO
YES NO
PLAN(S)
ONE TIME
1. Provide a list of employees that will receive the allowance or bonus/award payment. Include total number of employees. PII information, e.g., name
and social security number, should be provided on a password protected document. Send password to [email protected] in a
separate email. Provide attachment if additional lines are needed.
4. Will the plan allow employee to make up a missed employee contribution?
YES NO
DOLLAR AMOUNTPERCENTAGE BOTH
11. If agency currently has a FSA plan, is an employee allowed to enroll in more than one plan at a time?
FORM AD-3003 (REV. 2/23)PAGE 3 OF 5
SECTION C – NEW FLEXIBLE SPENDING ACCOUNT (FSA) PLAN
1. What Department/Agency will use the new FSA? (Provide attachment if additional lines are needed.)
2. What new FSA(s) are being proposed to implement in your organization? (Provide attachment if additional lines are needed.)
4. Will the new FSA have a vendor? If yes, provide information to the right. (Table 80 info)
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
3. Is new FSA tax-deferred?
YES NO
NAME ADDRESS:
ROUTING NUMBER: ACCOUNT NUMBER:
5. What is the eective date for the new FSA? 6. What is the minimum/maximum deduction allowed per pay period for the new FSA?
MINIMUM DEDUCTION MAXIMUM DEDUCTION
7. Will the deduction amount be divided by 26 pay periods?
9. Will the new FSA be mandatory or voluntary for employees? (If mandatory, how many employees will be implemented?)
MANDATORY VOLUNTARY NUMBER OF EMPLOYEES
12. Does employee need to re-enroll each year?
10. When is enrollment allowed? (e.g., Open Season/Annually, Pay Period, etc.?) (Provide attachment if additional lines are needed.)
8. Will employee be able to start, stop, or change at any time?
13. Will the new FSA be added to the Personal Benets Statement? (If yes, provide plan names. Provide attachment if additional lines are needed.)
Notes:
• Tables TM80 & TM85 will be updated for this request by NFC.
• NFC will provide a payment le with deduction data (e.g., employee name, SSN, and deduction amount) to the agency.
• NFC will provide a report that contains the payment le data.
• A plan code will be assigned by NFC for a new FSA.
SECTION D – NEW PAY PLAN/BAND
1. List the pay plan/band, grade, step, minimum/maximum salary (If more than one new pay plan/band is requested, or if additional lines are needed, provide
on attachment.)
PAY PLAN/BAND GRADE: STEP: MINIMUM/MAXIMUM SALARY:
3. If employees are currently serviced by NFC, provide a cross-walk and/or any additional information describing the existing pay plan/band and the new pay
plan/band (edits, pay caps, etc. Provide attachment if additional lines are needed.)
4. Current Pay Plan/Band (Provide attachment if additional lines are needed.)
5. New Pay Plan/Band (Provide attachment if additional lines are needed.)
SALARY/LOCALITY
2. Will the new pay plan/band receive standard government salary/locality pay? If no, provide the locality information that corresponds to each grade and step.
(Provide attachment if additional lines are needed.)
YES NO
FORM AD-3003 (REV. 2/23)PAGE 4 OF 5
8. What personnel nature of action codes will be used to migrate the employees to new pay plan/band?
9. How many employees will be implemented into the new pay plan/band?
10. Can employees assigned to the pay plan/band receive overtime?
YES
YES
NO
NO
11. Will a salary cap apply? If yes, dene. (Provide attachment if additional lines are needed.)
12. How will the pay plan/band be calculated? (Annual-To-Hourly-Rate Divisor of 2087, etc. Provide attachment if additional lines are needed.)
YES NO
SECTION E – AGENCY REORGANIZATION
1. What is the reason for mass data adjustment?
REALIGNMENT POI CHANGE REALIGNMENT ORGANIZATIONAL STRUCTURE CHANGEPOSITION DESCRIPTION (PD NUMBER) CHANGE REASSIGNMENT
OTHER (PLEASE SPECIFY REASON FOR MASS DATA ADJUSTMENT.)
2. Will PMSO records be updated by NFC? If no, go to question #4. If yes, provide information below and complete #3 below.
YES
NO
DEPARTMENT CODE AGENCY CODE PERSONNEL OFFICE IDENTIFIER SERVICING AGENCY CODE
OTHER (Please specify criteria. Provide attachment if additional lines are needed.)
NATURE OF ACTION (NOA)
ADDITIONAL DATA REQUIRED (Provide attachment if additional lines are needed.)
4. What is the selection criteria for individual positions?
ACTIVE POSITIONS
OCCUPIED ONLY INCLUDE VACANT OTHER:
5. What action is requested for the disposition of former positions? (Choose One)
LEAVE VACANT AND ACTIVE
ABOLISH INACTIVATE
6. Should SF-50s be generated?
7. Are other specications required not listed above? (Attach additional pages, if necessary or list below.)
YES NO
YES NO
8. Additional Specications (Provide attachment if additional lines are needed.)
13. Will the new pay plan/band aect any other benets, e.g., life insurance coverage amounts? if yes, dene. (Provide attachment if additional lines are needed.)
PERSONNEL ACTION EFFECTIVE DATE
PAY PERIOD EFFECTIVE
AUTHENTICATION DATE LEGAL AUTHORITY AUTHORITY CODE REMARKS CODE
6. Will employees assigned to the new pay plan/band be entitled to within grade increases? Describe the within grade increase timeframes
(Provide attachment if additional lines are needed.).
7.Will employees assigned to the new pay plan/band receive merit increase or annual pay raise?
YES
YES
YES
NO
NONO
MERIT INCREASE ANNUAL PAY RAISE
3. Which personnel action data elements will be included in the mass data adjustment?
NOTE: If accounting information will be changing as a result of this change, add those requirements in the eld labeled OTHER.
FORM AD-3003 (REV. 2/23)PAGE 5 OF 5
SECTION F – EmpowHR
1. Identify type of request.
PAR PROCESSING
HISTORY OVERRIDE
PAYROLL DOCUMENTS
PERFORMANCE MANAGEMENT
MANAGER SELF-SERVICE
EMPLOYEE SELF-SERVICE
THIRD PARTY INTEGRATION
NON-EMPLOYEE PROCESSING
AGENCY IMPLEMENTATION TO EMPOWHR
WORKLIST/WORKFLOW MANAGEMENT
REORGANIZATION/REALIGNMENT
DATA FILE INTERFACE (PLEASE COMPLETE #2)
2. Data File Interfaces Only
3. Is this a new or existing interface? If new, complete 2b – 2j. If existing, provide the interface name and details of changes.
NEW YES
YES
NO
NO
EXISTING YES NO
4. What is the new data le format?
COMMA SEPARATED VALUES (CSV)
PIPE DELIMITED
XML
EXCEL
OTHER (PLEASE SPECIFY)
DAILY
WEEKLY
BI-WEEKLY
MONTHLY
OTHER (PLEASE SPECIFY)
6. Are header and footer rows needed? If yes, NFC will contact you for details.
7. Is initial load (SEED) le required?
YES YES
YES
NO NO
NO
8. Is this for ‘full le’ or ‘changes only’?
FULL CHANGES ONLY
9. Should NFC overlay the previous le?
10. Will the le include PII data? If yes, please provide additional details (Provide attachment if additional lines are needed.)
11. Provide FTP details (e.g., IP address, destination le name, etc. Provide attachment if additional lines are needed.)
12. What data elements are needed? (Provide attachment if additional lines are needed.)
5. What frequency is needed for the new le?
OTHER (PLEASE SPECIFY)