White Paper Request for minor edits to Form 4939

Non-Substantive Change Request
VA Form 4939, Complaint of Employment Discrimination

Issue: The Department of Veterans Affairs, Office of Resolution Management (ORM), has updated VA Form 4939. This form is completed by VA employees, former employees and applicants for employment. The form includes Equal Employment Opportunity formal complaint information.

Discussion: This is a Non-Substantive Review request for OMB approval.

The proposed changes to VA Form:

Change (1)

General: Page 2:

It is your responsibility to keep the (ORM) informed of your current address. If you move, immediately advise the ORM Field Office where you filed this complaint of your new address. In addition, you may receive certified and express mail in connection with your complaint. It is your responsibility to claim all certified and express mail. Failure to notify ORM of a change in address or to claim certified and express mail may lead to dismissal of your complaint.

Change to:

It is your responsibility to keep the (ORM) informed of your current address. If you move, immediately advise the ORM District Office where you filed this complaint of your new address. In addition, you may receive certified and express mail in connection with your complaint. It is your responsibility to claim all certified and express mail. Failure to notify ORM of a change in address or to claim certified and express mail may lead to dismissal of your complaint.

Reason for Change: ORM changed the name of the offices from ORM Field Offices to ORM District Offices.

Change (2)

General: Page 2:

WHERE TO FILE: The complaint should be filed with the ORM Field Office identified in the NRTF or the Deputy Assistant Secretary for ORM. You may submit a copy either by mail, in person, electronically (via e-mail), or by facsimile. Filing instructions are contained in the cover letter attached to the NRTF.

Change to:

WHERE TO FILE: The complaint should be filed with the ORM District Office identified in the NRTF. You may submit a copy either by mail, in person, electronically (via e-mail), or by facsimile. Filing instructions are contained in the cover letter attached to the NRTF.

Reason for Change:

ORM changed the name of the offices from ORM Field Offices to ORM District Offices.

Individuals are submitting their formal complaint forms to the Deputy Assistant Secretary (DAS) for ORM. Upon receipt, they need to be routed to the proper District Office. This creates complaint processing delays. There is no regulatory requirement for the DAS to receive formal complaints of employment discrimination. This change will help expedite processing of formal complaints of employment discrimination.

Respondent Burden Time: The respondent burden time will not be affected by these non-substantive changes.

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