ࡱ> proS bjbj 4Ftiti vvvvv8Lc^b(]]]]]]]$`{c]v]vv^&{{{Fvv]{]{{V!@!eU%4R! ]'^<c^^!xkddkd!kdv!;{]]G4c^kdX <: Form B Application for Part-time Working and Partial Retirement from the NHSPS Section 1 To be completed by member of staff making the request Employee Name Department Faculty Current working hours and pattern per weekStart date for change of working hours and patternNew working hours and pattern per weekDate of 1st partial retirementAmount of NHSPS pension accessed when retired at 1st partial retirement(%)Date of 2nd partial retirementAmount of NHSPS pension accessed at 2nd partial retirement(%)Implications of change on the work of the department/team and suggestions for addressing these I have noted that if the request is approved, a minimum 4 months notice after approval date is required, to allow for pension processing in accordance with NHSPS requirements. Where applicable, I have applied to theHYPERLINK "https://www.gov.uk/government/publications/clinical-excellence-award-holders-employment-change-notification"Advisory Committee on Clinical Impact Awards (ACCIA)for my Clinical Excellence Award to be continued. Employee signed .. Date .. Section 2 To be completed by Line Manager and Head of Department Request approved Request not approved Please speak to your HR Consultancy contact before signing Reasons not approved state relevant criteria in Work Life Balance Policy Comments Line Manager and Head of Department Declaration: I confirm the following: I have considered this request in accordance with the criteria in the Work Life Balance Policy. Where approved, I agree the request meets the business needs of the department. I have contacted the NHS Billings Department (HYPERLINK "mailto:nhsbilling@ucl.ac.uk"nhsbilling@ucl.ac.uk) for advice on the elements of pensionable pay that can be reduced before a final decision is made for the partial retirement. Where the post is partially NHS Trust funded, I have liaised with the NHS trust and confirm that the application for partial retirement is jointly approved. Line Manager name: Signature Date: . Head of Department name: . Signature Date: The Line Manager must send copies of approved forms to ( the Departmental Administrator or Divisional/Institute Manager to process the reduction in hours ( UCL Pension Services to process the flexible retirement     &/6APQR     ! 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