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Judicial Watch • CMS Production

CMS Production

CMS Production

Page 1: CMS Production

Category:General

Number of Pages:9

Date Created:June 7, 2013

Date Uploaded to the Library:February 20, 2014

Tags:CMS, obtained, production, FOIA


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Stand11rd Form 
Rev. 7191 
NOTIFICATION PERSONNEL ACTION 
U.S. Office rcrsonncl Man11gement
FPM Supp. 296-33, Suhch. Name (Last, First, Middle) 
FIRST ACTION 
5-A. Code S-B. Nature Action 
Retirement-Voluntary 
S-C. Code S-D. Legal Authorily 
SQM U.S.C. 8336. Retire-ment undr CSRS opt provis 
S-E. Code 5-F. Legal Authority FROM: Position Title and Numher 
DIRECTOR, ENTERPRISE DATA CENTER GROUP 
PD:ES2281 
Position: OOl 45505 Pa Plan Occ.Code Grade/Le,cl Step/Rate Total Solary 0340 $179, 700.00 
12A. Basic Pay 128.Locality Adj. 12C. Adj. Basic Pay Other Pay 
$179, 700.00 $179, 700.00 
14. Name and Location Position's Organization 
Centers for Medicare Medicaid Services OFFICE THE ADMINISTRATOR CHIEF OPERA TING OFFICER OFFICE INFORMATION SERVICES ENTERPRISE DATA CENTER WOODLAWN USA 
EMPLOYEE DAT 
23. Veterans Preference 3-10-Poinlffiinhitity
-N""' 
2-!Ii-Point Hl-PoinllCompen,11hk
27. FEGLI Basic+ Option (Ix)+ Option 
30. Retirement Plan 
POSITION DATA 
34. Position Occupied 
-Compctltirc Service 2-E':cl."pll."cl Sl."r'icl." 
38. Dul)' Station Code 
241698005 
J-SES Genl."rul -1-SES Ci1reer Rl."cned 
40. Agenc)' Data 41. 
----------------
45. Remarks 
Forwarding address: 
-10-Point/Other
!'i
6-10-Point/C'ompl."nnhlc/30% 
31. Service Comp. Date (Leave) 
10-22-1976 
35. FLSA Categor)' 
E-Exempl -Nonexempt Social Security Number Date Birth 
SECOND ACTION 
6-A. Code 6-B. Nature Action 
6-C. Code 6-D. Legal Authorily 
6-E. Code 6-F. Legal Authorily 
IS. TO: Position Title and Number 
16. Pay Plan Occ.Code IK. Grade/Level20A. Desk Pay 208. LocnUty Adj. 
22. Name and Location Position's Organization 
24; Tenure 25. Agency Use 
2-Condilionnl 
3-lmknnitl."
28. Annuitant Indicator 
Not Applicable 
32. Work Schedule 
Full Time 
36. Appropriation Code 
25997400 
39. Duly Starion (Cily -Counly -State Overseas Location) 
WOODLAWN Baltimore USA 
42. 44. 
PAR Number: 
-------- - ------------- Effective Date 
10-01-2011 
20.Tote! Snlnry/Awnrd Pny Rns;s 20C.Adj. Bask Pay Other Pay 
----- )(6) 
26. Veterans Preference for RIF YES 1-xi 
29. Pay Rate [)eterminant 
Regular Rate 
33. Part-Time Hours Per Biweekl)'P)' Period 
37. Bargaining Unit Status 
8888 
Lump-sum payment made for auy unused annual leave. 
Reason for retirement: obtain retirement benefits. 
SF-8 Provided employee. 

46. Emplo)'ing Department Agency 50. Signature/Authentication and Title Approving Official 
Department HHS -Centers for Medicaid Services SMALL,DOUGLAS 
47. Agenc)' Code 48. Personnel Oflic 49. Approval Date Director, Client Service Center 
HE70 4222 09-22-2011 
5-Part 50-316 Editions Prior 7/91 Are Not Usable After 6/30/93 NSN 7540-01-333-6238 
-.-- ---..,....- ,,._. 
----CL-
Standard Fonn 
Rev 7/91 NOTIFICATION PERSONNEL ACTION Social Securir; Number Date Birth Effective Dote 
09-25-2011 
.. 

 
5-B Natl.ire Action 6-A. COdc 6-B. Nature Action 
CAN Change 

s-D.l.i:gal Auth6rity 6-C. Code 6-D. Logal Authority 
6-E. Code 6-F. Lognl Authority 
 
Is. Tei: P0sltion Title and NumliCr 
DIRECTOR QFM (CFO) Position: 00007148 PD:ES2172 Position: 00007148 
R.. Pay Pinn 9.0cc. 10.Grd/Lvl I.Step/Rate 12.Tny 
l2C. Adj. Basic Pay 120. Other Pay 20A. Basic Pay 20B. Local Adj. 
20C. Adj. Basic Pay 20D. Other Pay
$179,700.00 
14. Nome and L