DOE F 3230.6a DOE Report of Compensation Part 1 Individual Compensatio

OMB CONTROL NO.
1910-0600

DOE F 3230.6a
(04-91)
All Other Editions
Are Obsolete.

Burden Disclosure
Statement on Reverse

U.S. DEPARTMENT OF ENERGY

REPORT OF COMPENSATION
PART I – INDIVIDUAL COMPENSATION
FIELD OFFICE

REPORTING PERIOD (MONTH, YEAR)

LOCATION

CONTRACTOR

INPUT ID

5

5

SIGNATURE OF PERSON MAKING REPORT

5

SALARY

OTHER COMPENSATION

NAME

POSITION TITLE AND
ORGANIZATIONAL UNIT

BASE
SALARY

AMOUNT
REIMBURSED

PAYMENT

AMOUNT
REIMBURSED

1

2

3

4

5

6

OMB CONTROL NO.
1910-0600

DOE F 3230.6a
(04-91)
All Other Editions
Are Obsolete.

Burden Disclosure
Statement on Reverse

OMB Burden Disclosure Statement
Public reporting burden for this collection of information is estimated to average 8 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of
Information Resources Management Policy, Plans, and Oversight, AD-241.2 - GTN, Paperwork Reduction Project (1910-0600), U.S. Department of Energy,
1000 Independence Ave., S.W., Washington, DC 20585; and to the Office of Management and Budget (OMB), Paperwork Reduction Project
(1910-0600),Washington, DC 20503.