At the heart of the Department of Defense (DoD)'s approach to managing its workforce transitions is the DD Form 2903-3. This form is crucial for employees considering a voluntary exit from their roles through the Voluntary Separation Incentive Pay Agreement (VSIP), also known as a buyout. Authorized under Title 5, United States Code §9902(i), the form outlines the pact between an employee and the DoD, laying down the groundwork for receiving incentive payments in two six-month installments after separation. It stands as a testament to an employee's understanding and acceptance of the terms associated with the VSIP, including significant conditions like the repayment of the full buyout amount if the employee returns to any government employment within five years, or the prohibition from reemployment within the DoD for a year. The form captures essential employee details, the total buyout amount, payment terms, and signatures, ensuring both parties are clear on the agreement's specifics. By signing this document, employees also acknowledge that they have been properly counseled by their Human Resources Office, marking an irrevocable commitment to the transition process.
| Question | Answer |
|---|---|
| Form Name | Dd Form 2903 3 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | HRO, dd form 2903 1 fillable form, SSN, dss form 2903 |
VOLUNTARY SEPARATION INCENTIVE PAY AGREEMENT
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 9902(i), DoDD 1400.25, DoD
PRINCIPAL PURPOSE(S): This form serves as an agreement between a DoD employee and the Department of Defense when Voluntary Separation Incentive Pay (VSIP) has been approved. The agreement certifies the employee has been counseled and freely agrees to and fully understands the conditions and terms of the VSIP.
ROUTINE USE(S): None.
DISCLOSURE: Voluntary; however, failure to provide required information may result in denial of the VSIP.
1.Title 5, United States Code s9902(i) authorizes the Secretary of Defense to establish a program to pay a Voluntary s
Separation Incentive Payment (VSIP) or buyout to eligible employees. This is to certify that my application for the buyout is voluntary and the effective date of my separation shall be
request for the personnel action and the payment terms are irrevocable.
2.I understand that an employee who receives a buyout, and accepts employment with the Government of the United States (including employment in nonappropriated fund instrumentalities or with an agency of the United States through a personal services contract with the United States) within 5 years after the date of separation on which payment of the buyout is based, shall be required to repay the entire amount of the buyout (before taxes and deductions) to the Federal agency that paid the buyout. I also understand that a DoD employee who receives a buyout is prohibited from registering in the DoD Priority Placement Program and may not be reemployed by the Department of Defense in any capacity for a
a.NAME (Last, First, Middle Initial)
b. SSN
3.a. TOTAL BUYOUT AMOUNT
$
b. PAYMENT TERMS |
|
|
|
|
Receive one half of my buyout in the amount of $ |
|
, |
||
six months following the date of my separation and the second |
|
|||
half in the amount of $ |
|
six months later. |
|
|
c. INITIALS
4.This is to certify that I have been counseled by the Human Resources Office (HRO) and that I freely agree to and fully understand the conditions and terms of the buyout.
a. EMPLOYEE SIGNATURE
b.DATE (YYYYMMDD)
c. HRO REPRESENTATIVE SIGNATURE
b.DATE (YYYYMMDD)
DD FORM
Adobe Professional 7.0