{"text_format":"2","workbook":"xlsx","n_sheets":2,"sheets":["（別紙第６）１号紙","（別紙第６）２号紙"],"not_rendered":{"charts":0,"images":0,"macros":0,"external_links":0,"defined_names":2,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"run_cost":"one","rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"（別紙第６）１号紙","index":0,"n_rows":46,"n_cols":30,"rows_kept":46,"cut":false,"hidden":false,"merged":[[45,0,45,29],[31,1,31,4],[26,0,27,0],[26,1,27,4],[43,0,43,29],[26,25,27,28],[35,25,35,28],[32,13,33,13],[32,14,33,17],[32,18,33,19],[44,0,44,29],[40,0,41,5],[40,12,41,17],[40,18,41,20],[40,21,40,29],[41,21,41,29],[16,3,17,9],[16,10,17,10],[16,11,17,14],[16,15,17,15],[21,3,21,15],[20,0,23,2],[20,3,20,15],[37,25,37,28],[33,20,33,23],[32,20,32,23],[20,16,20,29],[21,16,21,29],[22,16,22,29],[23,16,23,29],[31,14,31,17],[32,29,33,29],[32,25,33,28],[29,25,29,28],[22,3,22,15],[23,3,23,15],[25,1,25,4],[1,0,1,29],[2,7,2,23],[3,7,3,23],[42,0,42,29],[32,0,33,0],[32,1,33,4],[32,5,33,6],[32,7,33,8],[32,9,33,10],[32,11,33,12],[12,20,12,29],[25,11,25,14],[26,11,27,14],[26,15,27,16],[27,17,27,21],[40,6,41,11],[9,12,10,14],[12,0,19,2],[18,9,19,29],[7,0,7,14],[16,24,16,28],[12,7,13,16],[13,22,13,23],[9,0,10,1],[9,2,9,11],[10,2,10,11],[8,17,9,29],[15,17,15,29],[10,17,10,20],[10,21,10,29],[11,24,11,29],[14,9,15,16],[39,0,39,29],[32,24,33,24],[26,17,26,21],[26,22,27,22],[26,29,27,29],[26,9,27,10],[26,5,27,6],[26,7,27,8]]}
["別紙第18"]
["国 家 公 務 員 災 害 補 償"]
[{"$nulls":7},"障害補償年金差額一時金請求書"]
[{"$nulls":7},"障害差額特別給付金支給申請書"]
[]
[{"$nulls":29},"１号紙"]
["（実施機関の長の官職氏名）",{"$nulls":16},"請求（申請）年月日",{"$nulls":5},"令和",null,"年",null,"月",null,"日"]
[{"$nulls":15},"殿",null,"請求（申請）者の住所"]
[]
["下記の",null,"障害補償年金差額一時金を請求",{"$nulls":9},"します。"]
[null,null,"障害差額特別給付金の支給を申請",{"$nulls":14},"氏名"]
[{"$nulls":17},"死亡職員との続柄"]
["１\n死亡職員\nに関する\n事項",null,null,"（所属部局）",{"$nulls":13},"（氏　名）"]
[{"$nulls":25},"年",null,"月",null,"日生"]
[null,null,null,"（官職）",null,null,"□","常　勤",{"$nulls":9},"（死亡年月日）",{"$nulls":5},"令和",null,"年",null,"月",null,"日"]
[{"$nulls":6},"□","非常勤"]
[null,null,null,"（死亡時の障害等級）",{"$nulls":6},"第",{"$nulls":4},"級",null,"（年金証書の番号）"]
[{"$nulls":23},"第",{"$nulls":5},"号"]
[null,null,null,"（既存障害とその程度）"]
[]
["２\n受給権者に関する事項",null,null,"氏　　　　　　　　　　　　　　　名",{"$nulls":12},"死　亡　職　員　と　の　続　柄"]
[]
[]
[]
["３　障害補償年金差額一時金"]
[null,"（平均給与額）",{"$nulls":9},"（Ｄ）"]
["（",{"$nulls":4},"円 ×",null,null,null,"日分 －",{"$nulls":5},"円）×",null,"１",{"$nulls":4},"＝",{"$nulls":6},"円"]
[{"$nulls":17},"（受給権者の数）"]
["（障害補償年金差額一時金請求額）"]
[{"$nulls":29},"円"]
["４　障害差額特別給付金"]
[null,"（平均給与額）",{"$nulls":7},"（特別給支給率）",{"$nulls":4},"（Ｇ）"]
["⑴（",{"$nulls":4},"円 ×",null,null,null,"日分 ×",null,null,null,"－",{"$nulls":4},"円）×",null,"１",null,null,null,"＝",{"$nulls":4},"円"]
[{"$nulls":20},"（申請者の数）"]
["⑵ 規則16-3第19条の13第1項又は第2項の規定に基づき150万円を基礎として算定した額"]
[{"$nulls":29},"円"]
["（障害差額特別給付金支給申請額）"]
[{"$nulls":29},"円"]
["５　添付する書類その他の資料名"]
[]
["※受理\n令和 　年　 月　 日",{"$nulls":5},"※決定\n令和　 年　 月　 日",{"$nulls":5},"※支払\n令和 　年　 月 　日",{"$nulls":5},"※決定\n　金額",null,null,"障害補償年金差額一時金　　　　　円"]
[{"$nulls":21},"障害差額特別給付金　　　　　　　円"]
["　注１　請求（申請）者は、※印の欄には記入しないこと。該当する□にレ印を記入すること。"]
["　　２　「（既存障害とその程度）」の欄には、新たに既存の障害を加重した場合に記入するものとし、特に既\n　　　存障害について障害補償を支給された場合は、その該当する障害等級を明記すること。"]
["　　３　この請求（申請）書には、平均給与額算定書及び特別給支給率の算定の基礎を明らかにすることができ"]
["　　　る書類を添付すること。"]

{"sheet":"（別紙第６）２号紙","index":1,"n_rows":29,"n_cols":24,"rows_kept":29,"cut":false,"hidden":false,"merged":[[13,4,13,5],[15,0,15,6],[15,7,15,12],[16,7,16,11],[10,0,10,1],[10,4,10,5],[10,2,10,3],[12,7,12,11],[27,2,27,3],[24,2,24,3],[25,2,25,3],[26,2,26,3],[23,7,23,11],[23,2,23,3],[5,0,5,5],[11,0,11,1],[12,0,12,1],[11,4,11,5],[12,4,12,5],[11,2,11,3],[12,2,12,3],[9,0,9,1],[9,4,9,5],[9,2,9,3],[7,0,7,1],[8,0,8,1],[7,2,7,3],[8,2,8,3],[7,4,7,5],[8,4,8,5],[5,6,5,12],[10,7,10,11],[11,7,11,11],[5,13,5,17],[5,18,5,23],[7,14,7,16],[8,14,8,16],[9,14,9,16],[7,18,7,22],[8,18,8,22],[9,18,9,22],[10,14,10,16],[11,14,11,16],[7,7,7,11],[8,7,8,11],[9,7,9,11],[13,22,13,23],[13,17,13,21],[10,18,10,22],[11,18,11,22],[12,18,12,22],[12,14,12,16],[17,22,17,23],[17,17,17,21],[22,2,22,3],[19,0,20,3],[21,4,21,12],[22,7,22,11],[19,4,20,12],[19,13,20,17],[22,14,22,16],[15,13,15,17],[16,14,16,16],[15,18,15,23],[16,22,16,23],[16,18,16,21],[26,14,26,16],[27,14,27,16],[24,7,24,11],[25,7,25,11],[26,7,26,11],[27,7,27,11],[4,0,4,7],[28,8,28,9],[28,22,28,23],[28,17,28,21],[2,18,2,19],[2,20,2,23],[19,18,20,23],[22,18,22,22],[23,18,23,22],[24,18,24,22],[25,18,25,22],[26,18,26,22],[27,18,27,22],[23,14,23,16],[24,14,24,16],[25,14,25,16]]}
[]
[{"$nulls":23},"２号紙"]
[{"$nulls":18},"氏名",null,{"$f":"'（別紙第６）１号紙'!V11","v":0}]
["６　既に支給された障害補償年金又は障害補償年金前払一時金の計算"]
["障害補償年金が支給されていた場合"]
["支給月の属する年度",{"$nulls":5},"支給された年金額（Ａ）",{"$nulls":6},"人事院が定める率(Ｂ)",{"$nulls":4},"（Ａ）×（Ｂ）"]
["　　　　　　　　　　　　",{"$nulls":5},"（平均給与額）×（日数）　　",{"$nulls":6},"　　　　　　　　　　"]
[{"$nulls":4},"年　度",{"$nulls":7},"円","　　　　　　　　　　",{"$nulls":4},{"$f":"H8*O8","v":0},{"$nulls":4},"円"]
[{"$nulls":4},"年　度",{"$nulls":7},"円","　　　　　　　　　　",{"$nulls":4},{"$f":"H9*O9","v":0},{"$nulls":4},"円"]
[{"$nulls":4},"年　度",{"$nulls":7},"円","　　　　　　　　　　",{"$nulls":4},{"$f":"H10*O10","v":0},{"$nulls":4},"円"]
[{"$nulls":4},"年　度",{"$nulls":7},"円","　　　　　　　　　　",{"$nulls":4},0,{"$nulls":4},"円"]
[{"$nulls":4},"年　度",{"$nulls":7},"円","　　　　　　　　　　",{"$nulls":4},0,{"$nulls":4},"円"]
[{"$nulls":4},"年　度",{"$nulls":7},"円","　　　　　　　　　　",{"$nulls":4},0,{"$nulls":4},"円"]
[{"$nulls":4},"計",{"$nulls":17},"円（Ｃ）"]
["障害補償年金前払一時金が支給されていた場合"]
["支給年月日",{"$nulls":6},"支給された前払一時金の額(Ａ´)",{"$nulls":5},"人事院が定める率(Ｂ´)",{"$nulls":4},"(Ａ´)×(Ｂ´)"]
[null,null,"年",null,"月",null,"日",{"$nulls":5},"円","　　　　　　　　　　",{"$nulls":4},{"$f":"H17*O17","v":0},null,null,null," 円(Ｃ´)"]
[{"$nulls":5},"総　　　　計(Ｃ)＋(Ｃ´) ",{"$nulls":16},"円（Ｄ）"]
["７　既に支給された障害差額特別給付金の計算"]
["支給月の\n属する年度",null,null,null,"支給された遺族特別給付金（年金）の額\n（Ｅ）",{"$nulls":8},"人事院が定める率(Ｆ)",{"$nulls":4},"（Ｅ）×（Ｆ）"]
[]
[{"$nulls":4},"(平均給与額)×(日数)×(特別給支給率)"]
[null,null,"年　度",{"$nulls":9},"円","　　　　　　　　　　",{"$nulls":4},{"$f":"H23*O23","v":0},{"$nulls":4},"円"]
[null,null,"年　度",{"$nulls":9},"円","　　　　　　　　　　",{"$nulls":4},{"$f":"H24*O24","v":0},{"$nulls":4},"円"]
[null,null,"年　度",{"$nulls":9},"円","　　　　　　　　　　",{"$nulls":4},0,{"$nulls":4},"円"]
[null,null,"年　度",{"$nulls":9},"円","　　　　　　　　　　",{"$nulls":4},0,{"$nulls":4},"円"]
[null,null,"年　度",{"$nulls":9},"円","　　　　　　　　　　",{"$nulls":4},0,{"$nulls":4},"円"]
[null,null,"年　度",{"$nulls":9},"円",{"$nulls":5},0,{"$nulls":4},"円"]
[{"$nulls":8},"計",{"$nulls":13},"円（Ｇ）"]