EEOC Form 573 at a glance
What it is: EEOC Form 573, Notice of Appeal/Petition, solicits information to enable the Commission to adjudicate appeals filed by federal employees, former federal employees, and applicants for federal employment.
Who signs: Signature of complainant or complainant's representative, and the Date.
A filled-in EEOC Form 573 example: a federal employee appeals a final action
How to fill out EEOC Form 573, box by box
Complainant Information
Print or type the Complainant's name (Last, First, M.I.), Home/mailing address, City, State, ZIP Code, Daytime Telephone # (with area code) and E-mail address (if any).
Attorney/Representative Information
Under Attorney/Representative Information (if any), enter the Attorney name or the Non-Attorney Representative name, the Address, City, State, ZIP Code, Telephone number (if applicable) and E-mail address (if any).
General Information
Under General Information, enter the Name of the agency being charged with discrimination, identify the Agency's complaint number, and the Location of the duty station or local facility in which the complaint arose.
Final action on the complaint
Has a final action been taken by the agency, an Arbitrator, FLRA, or MSPB on this complaint? If Yes, enter the Date Received and remember to attach a copy.
Mark the box if this appeal alleges a breach of a settlement agreement.
Another complaint on the same matter
Has a complaint been filed on this same matter with the Commission, another agency, or through any other administrative or collective bargaining procedures? If Yes, indicate the agency or procedure, complaint/docket number, and attach a copy, if appropriate.
Civil action
Has a civil action (lawsuit) been filed in connection with this complaint? If Yes, attach a copy of the civil action filed.
Signing, service and accommodations
Please specify any reasonable accommodations you will require to participate in the appeal process.
Signature of complainant or complainant's representative, and the Date.
Enter the Method of Service on Agency and the Date of Service.
More rules for EEOC Form 573
Please attach a copy of the final decision or order from which you are appealing.
If a hearing was requested, please attach a copy of the agency's final order and a copy of the Commission Administrative Judge's decision.
Failure to supply the Commission with the requested information could hinder timely processing of your case, or even result in the rejection or dismissal of your appeal.
Common questions about EEOC Form 573
Is there a deadline?
Any comments or brief in support of this appeal must be filed with the Commission and with the agency within 30 days of the date this appeal is filed. The date the appeal is filed is the date on which it is postmarked, hand delivered, submitted, or faxed to the Commission.
Where do I file it?
You may send your appeal to: The Equal Employment Opportunity Commission Office of Federal Operations P.O. Box 77960 Washington, DC 20013. Fax it to (202) 663-7022 or submit it through the Commission's electronic submission portal.
Sources
[1] EEOC Form 573 (REV 2/09), Notice of Appeal/Petition - Complainant, U.S. Equal Employment Opportunity Commission (the Official source link on this page).