PS Form 1216, Employee`s Current Mailing Address

Employee’s Current Mailing Address
Employee Name (Last, First, MI)
Home Telephone No.
Mailing Address (No., Street, City, State, and ZIP + 4)
Residence Address
Emergency Contact Name
Telephone No.
Effective Date
Change Bond Mailing Address to Same as Mailing Address
(See Note Below)
NOTE: This will change ALL bond mailing addresses. If you have
multiple bond allotments and wish to change individual mailing
addresses, submit Forrm 1192, U.S. Savings Bond Authorization for
Purchase and Request for Change, to your personnel office.
SSN
Same as Mailing
Date Signed
Employee Signature
FOR EMPLOYING OFFICE USE ONLY
Finance No.
Pay Loc. Installation Name
Privacy Act Statement
The collection of this information is authorized by 39 USC 401, 1001, 1003, 1005; and 5 USC 8339.
This information will be used to handle all necessary payroll functions for use by employee supervisors
for the performance of their managerial duties and to support USPS personnel programs. As a routine
use, the information may be disclosed to an appropriate government agency, domestic or foreign, for
law enforcement purposes; where pertinent, in a legal proceeding to which the USPS is a party or has
an interest; to a government agency in order to obtain information relevant to a USPS decision
concerning employment, security clearances, contracts, licenses, grants, permits or other benefits; to a
government agency upon its request when relevant to its decision concerning employment, security
clearances, security or suitability investigations, contracts, licenses, grants or other benefits; to a
congressional office at your request; to an expert, consultant, or other person under contract with the
USPS to fulfill an agency function; to the Federal Records Center for storage; to the Office of
Management and Budget for review of private relief legislation; to an independent certified public
accountant during an official audit of USPS finances; to an investigator, administrative judge or
complaints examiner appointed by the Equal Employment Opportunity Commission for investigation of
a formal EEO complaint under 29 CFR 1613; to the Merit Systems Protection Board or Office of Special
Counsel for proceedings or investigations involving personnel practices and other matters within their
PS Form 1216, June 1993 (Older Editions Not Usable)
jurisdiction; to a labor organization as required by the National Labor Relations Act; to agencies having
taxing authority for taxing purposes; to financial organizations receiving allotments; to State
Employment Security Agencies to process unemployment compensation claims; to a Federal or state
agency providing parent locator service or to other authorized persons as defined by Pub. L. 93-647; to
the National Association of Postal Supervisors that relates to postal supervisors; to a prospective
employer for consideration of employment; to management for compilation of a local seniority list for
posting; to the EEOC for enforcement of Federal EEO regulations; to the appropriate finance center as
required under the provisions of the Dual Compensation Act; to the Office of Personnel Management,
Social Security Administration, Veterans Administration, Office of Workers’ Compensation Programs,
health insurance carriers, or plans, or other program management agencies or retirement systems for
use in determining a claim for benefits; and to OPM for its active employee/annuitant data systems
used to analyze Federal Retirement and insurance costs. Completion of this form is mandatory.
Failure to do so would prevent supervisors from contacting employees on routine or emergency
matters. Savings Bonds, Postal magazines, Forms W-2, and other mailings would be sent to the wrong
address.
1 - Processing Copy
Employee’s Current Mailing Address
Employee Name (Last, First, MI)
Home Telephone No.
Mailing Address (No., Street, City, State, and ZIP + 4)
Residence Address
Emergency Contact Name
Telephone No.
Effective Date
Change Bond Mailing Address to Same as Mailing Address
(See Note Below)
NOTE: This will change ALL bond mailing addresses. If you have
multiple bond allotments and wish to change individual mailing
addresses, submit Forrm 1192, U.S. Savings Bond Authorization for
Purchase and Request for Change, to your personnel office.
SSN
Same as Mailing
Date Signed
Employee Signature
FOR EMPLOYING OFFICE USE ONLY
Finance No.
Pay Loc. Installation Name
Privacy Act Statement
The collection of this information is authorized by 39 USC 401, 1001, 1003, 1005; and 5 USC 8339.
This information will be used to handle all necessary payroll functions for use by employee supervisors
for the performance of their managerial duties and to support USPS personnel programs. As a routine
use, the information may be disclosed to an appropriate government agency, domestic or foreign, for
law enforcement purposes; where pertinent, in a legal proceeding to which the USPS is a party or has
an interest; to a government agency in order to obtain information relevant to a USPS decision
concerning employment, security clearances, contracts, licenses, grants, permits or other benefits; to a
government agency upon its request when relevant to its decision concerning employment, security
clearances, security or suitability investigations, contracts, licenses, grants or other benefits; to a
congressional office at your request; to an expert, consultant, or other person under contract with the
USPS to fulfill an agency function; to the Federal Records Center for storage; to the Office of
Management and Budget for review of private relief legislation; to an independent certified public
accountant during an official audit of USPS finances; to an investigator, administrative judge or
complaints examiner appointed by the Equal Employment Opportunity Commission for investigation of
a formal EEO complaint under 29 CFR 1613; to the Merit Systems Protection Board or Office of Special
Counsel for proceedings or investigations involving personnel practices and other matters within their
PS Form 1216, June 1993 (Older Editions Not Usable)
jurisdiction; to a labor organization as required by the National Labor Relations Act; to agencies having
taxing authority for taxing purposes; to financial organizations receiving allotments; to State
Employment Security Agencies to process unemployment compensation claims; to a Federal or state
agency providing parent locator service or to other authorized persons as defined by Pub. L. 93-647; to
the National Association of Postal Supervisors that relates to postal supervisors; to a prospective
employer for consideration of employment; to management for compilation of a local seniority list for
posting; to the EEOC for enforcement of Federal EEO regulations; to the appropriate finance center as
required under the provisions of the Dual Compensation Act; to the Office of Personnel Management,
Social Security Administration, Veterans Administration, Office of Workers’ Compensation Programs,
health insurance carriers, or plans, or other program management agencies or retirement systems for
use in determining a claim for benefits; and to OPM for its active employee/annuitant data systems
used to analyze Federal Retirement and insurance costs. Completion of this form is mandatory.
Failure to do so would prevent supervisors from contacting employees on routine or emergency
matters. Savings Bonds, Postal magazines, Forms W-2, and other mailings would be sent to the wrong
address.
2 - Supervisor/Work Unit Copy