EEO Complaint Forms

OMB 1505-0262

Treasury employees, former employees, and applicants for employment may contact the Department’s EEO Offices if they believe they have been subjected to discrimination based on race, color, sex (includes sexual harassment, sexual orientation and gender identity), national origin, religion, disability, age (40 or over), parental status, protected genetic information, or retaliation. A Treasury staff member responsible for obtaining information regarding the claim(s) of discrimination will record on a Report of Counseling (Intake) Form the aggrieved party’s (“the aggrieved”) personal information, i.e., name, address, telephone numbers, etc., as well as the bases and issues raised by the aggrieved. Thereafter, an EEO Counselor will be assigned, who will review the information on the Report of Counseling (Intake) Form and contact the aggrieved to schedule an initial interview. This interview may include, but is not limited to: verifying the information on the Intake Form, clearly defining the scope of the issues, reviewing the rights and responsibilities of the aggrieved and the agency during the EEO complaint process including the right to representation and anonymity, the applicable time frames, the option to extend the counseling process, the right to choose between Alternative Dispute Resolution (ADR) and EEO Counseling, and the overall stages of the complaint process.

The latest form for EEO Complaint Forms expires 2022-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form TD F 63-03.5 Formal Complaint Form Form and Instruction
Form TD F 62-03.10 Class Complaint Form and Instruction
Form TD F 32.03-9 Notice of Withdrawal from Participation in the EEO Pre-Complaint Process Form and Instruction
Form TD F 62-03.8 Notice of Right to FIle Form and Instruction
Form TD F 62.03.7 Notice of Rights and Responsabilities Form and Instruction
Form TD F 62-03.6 Agreement to Extend Counseling Form and Instruction
Form TD F 62-03.4 Agreement to Extend Counseling to Participate in Mediation Form and Instruction
Form TD F 62-03.2 Designation of Represenative Form and Instruction
Form TD F 62-03.1 EEO Informal Report of Counseling Form and Instruction
Form TD F 62-03.11 ADR Election Form Form
Memo Regarding Minor Updates to OMB Approved Forms 8-9-2022.pdf Justification for No Material/Nonsubstantive Change
1505-0262 SS 2022.docx Supporting Statement A
Formal Complaint Form Form and Instruction
Class Complaint Form and Instruction
Notice of Withdrawal from Participation in the EEO Pre-Complaint Process Form and Instruction
Notice of Right to FIle Form and Instruction
Notice of Rights and Responsabilities Form and Instruction
Agreement to Extend Counseling Form and Instruction
Agreement to Extend Counseling to Participate in Mediation Form and Instruction
Designation of Represenative Form and Instruction
EEO Informal Report of Counseling Form and Instruction
ADR Election Form Form

All Historical Document Collections

202208-1505-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2022-08-11
202207-1505-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2022-07-15
202203-1505-006 Approved without change	Extension without change of a currently approved collection	2022-03-31
201705-1505-001 Approved with change	New collection (Request for a new OMB Control Number)	2018-03-26

OMB Details

ADR Election Form

Federal Enterprise Architecture: Workforce Management - Labor Rights Management

Form TD F 62-03.11

ADR Election Form

Fillable Fileable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.