Ps Form 2564 A – Fill Out and Use This PDF

The PS Form 2564-A serves a crucial role in the United States Postal Service (USPS) framework, specifically designed for employees and applicants to initiate pre-complaint counseling regarding allegations of discrimination. The form outlines a structured process for individuals to document their experiences, ranging from the type of discrimination faced to desired resolutions and the option for representation, emphasizing the USPS's commitment to addressing and resolving such issues. To ensure your concerns are promptly and thoroughly addressed, consider filling out the PS Form 2564-A by clicking the button below.

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Ps Form 2564 A PDF Details

The PS 2564 A form serves as a crucial initial step for employees or applicants of the U.S. Postal Service who seek to address and resolve issues of alleged discrimination before lodging a formal complaint. It facilitates a structured process for pre-complaint counseling, mandating the prompt completion and return of the form within a ten-day window upon receipt. This document meticulously captures essential personal and employment details, alongside specific allegations of discrimination based on various factors such as race, color, religion, sex, age, national origin, physical or mental disability, and retaliation for previous EEO activity. Notably, it encourages individuals to articulate the incident that has prompted the seek for EEO counseling, including any comparative instances demonstrating unequal treatment, and to identify the officials responsible for the alleged discriminatory actions. The form also explores the aspirant’s desired resolution, any prior grievance or MSPB appeal related to the incident, and the choice regarding anonymity and representation throughout the process. Additionally, it underscores the importance of submitting relevant documentation to support one’s allegations while providing a comprehensive overview of how the collected information will be utilized and shared, in compliance with various legal statutes and privacy act provisions. This meticulous approach is aimed at ensuring a fair, transparent, and effective resolution mechanism for grievances related to workplace discrimination within the Postal Service.

Question	Answer
Form Name	Ps Form 2564 A
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	postal service eeo complaint form, ps 2564 form, eeo form postal fill, usps eeoc

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U.S. Postal Service

Information for Pre-Complaint Counseling

Certified Mail No.	Date Mail	or Hand Delivered On


By (Initials)	Case No.

On _________________________________, you requested an appointment with a Dispute Resolution Specialist.

Month, Day, Year

Important: Please Read. You should complete this form and return it to the EEO office within 10 calendar days of receipt. This the only notification that you will receive regarding the necessity for you to complete this form.

A. Requester Information

Name (Last, First, MI)

Social Security No.

Home Telephone No.

()

Your Mailing Address

Name of Postal Facility Where You Work

Office Telephone No.

()

Address of Postal Facility					Email Address *

Employment Status (Check One)				Position Title		Grade Level
Applicant	Casual	TE	Career

Pay Location	Tour	Duty Hours		Off Days (If Tour I, Show Nights Off)		Time in Current Position
						____ Years		____ Months

Your Supervisor’s Name				Supervisor’s Title		Supervisor’s Telephone No.
						(	)

*Providing this information will authorize the U.S. Postal Service to send you important documents electronically.

B. Discrimination Factors

Prohibited discrimination includes actions taken based on your Race, Color, Religion, Sex, Age (40+), National Origin, Physical and/or Mental

Disability, or in Retaliation (actions based on your participation in prior EEO activity). These categories are referred to on this form as factors.

What Factor(s) of Discrimination Are You Alleging? (Please be specific, i.e., Race - African American, Sex - Female.)

For Retaliation Allegations Only: If you are alleging retaliation discrimination, provide the date(s) and specifics of the EEO activity which you feel caused you to be retaliated against.

1.	On ___________________________, I engaged in EEO activity.	Case No.: __________________________.
	Month, Day, Year
2.	On ___________________________, I engaged in EEO activity.	Case No.: __________________________.
	Month, Day, Year

C. Description of Incident/Activity

Please use the space below to briefly describe the incident or action that prompted you to seek EEO counseling at this time.

On _____________________________________, 20____,

	Month, Day	Year

PS Form 2564-A, March 2001 (Page 1 of 3)

D. Comparisons

Explain why, based on the factors you cited in Section B, you believe that you were treated differently than other employees or applicants in similar situations.

(Name of Employee)

Factor(s) that describe the employee, i.e., sex (male), National Origin (Hispanic)

was treated differently than I when:

(Name of Employee)

Factor(s) that describe the employee, i.e., sex (male), National Origin (Hispanic)

was treated differently than I when:

(Name of Employee)

Factor(s) that describe the employee, i.e., sex (male), National Origin (Hispanic)

was treated differently than I when:

E. Official(s) Responsible for Action(s)

List the name(s) of the official(s) who took the action which prompted you to seek counseling at this time.

1a. Name

b. Title

c. Office

d. Grade Level

2a. Name

b. Title

c. Office

d. Grade Level

Retaliation Allegations Only: Was/were the official(s) listed in Section E above aware of your prior EEO activity?

Yes	No	If yes, explain how the official(s) became aware:

F. Resolution

What are you seeking as a resolution to your pre-complaint?

G. Grievance/MSPB Appeal

On the incident that prompted you to seek EEO counseling, have you:

1.	Filed a grievance on the issue?	No	Yes	If yes,
					(Date)	(Current Step)
2.	Filed an MSPB appeal on this issue?	No	Yes	If yes,
					(Date Appeal Filed)

PS Form 2564-A, March 2001 (Page 2 of 3)

H. Anonymity

You have the right to remain anonymous during the pre-complaint process.

Do you desire anonymity?

Yes

I. Representation

You have the right to retain representation of your choice. (Check One)

I waive the right to representation at this time.

I authorize the person listed below to represent me.

Name of Representative

Organization

Representative’s Title

Telephone No.

Email Address *

()

Mailing Address (Street or P.O. Box, City, State and ZIP + 4)

*Providing this information will authorize the U.S. Postal Service to send your representative important documents electronically.

J. Documentation

Please attach any documentation you wish to submit to support your allegation(s) Include a copy of any written action(s) that caused you to seek counseling at this time.

Note: If you are alleging mental and/or physical disability, it is important for you to submit medical documentation of your disability during the pre- complaint process.

K. Privacy Act Statement

Privacy Act Notice. The collection of this information is authorized by the Equal Employment Opportunity Act of 1972, 42 U.S.C. § 2000e-16; the Age Discrimination in Employment Act of 1967, as amended, 29 U.S.C. § 633a; the Rehabilitation Act of 1973, as amended, 29 U.S.C. § 794a; and Executive Order 11478, as amended. This information will be used to adjudicate complaints of alleged discrimination and to evaluate the effectiveness of the EEO program. As a routine use, this information may be disclosed to an appropriate government agency, domestic or foreign, for law enforcement purposes; where pertinent, in a legal proceeding to which the USPS is a party or has an interest; to a government agency in order to obtain information relevant to a USPS decision concerning employment, security clearances, contracts, licenses, grants, permits or other benefits; to a government agency upon its request when relevant to its decision concerning employment, security clearances, security or suitability investigations, contracts, licenses,

grants or other benefits; to a congressional office at your request; to an expert, consultant, or other person under contract with the USPS to fulfill an agency function; to the Federal Records Center for storage; to the Office of Management and Budget for review of private relief legislation; to an independent certified public accountant during an official audit of USPS finances; to an investigator, administrative judge or complaints examiner appointed by the Equal Employment Opportunity Commission for investigation of a formal EEO complaint under 29 CFR 1614; to the Merit Systems Protection Board or Office of Special Counsel for proceedings or investigations involving personnel practices and other matters within their jurisdiction; and to a labor organization as required by the National Labor Relations Act. Under the Privacy Act provision, the information requested is voluntary for the complainant, and for Postal Service employees and other witnesses.

L. Authorization

I am aware that the claim(s) contained herein shall by-pass the pre-complaint process if like or related to a formal complaint that I have already filed, or if the claim(s) constitutes a spin-off complaint. (A spin-off complaint contests the manner in which a previously filed complaint is being processed.) In completing this PS Form 2564-A, Information for Pre-Complaint Counseling, I recognize that the Manager, Dispute Resolution, will review the claim(s) contained herein and determine how they shall be processed. I will be notified, in writing, if the Manager determines that my claim(s) shall be processed as amendments or appendages to a formal complaint that I have already filed.

Please Print Your Name Here

Your Signature

Date Signed

Please Return This Form to:

EEO Processing

P O Box 1017

Dallas, Texas 75221-1017

PS Form 2564-A, March 2001 (Page 3 of 3)

How to Edit Ps Form 2564 A Online for Free

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Step 1: Hit the "Get Form Now" button to get started on.

Step 2: You can now update your usps eeoc. Our multifunctional toolbar can help you include, erase, improve, and highlight content as well as carry out other sorts of commands.

For you to obtain the template, enter the content the application will require you to for each of the next sections:

Provide the expected data in the Your Supervisors Name, Years Months Supervisors, Supervisors Title, B Discrimination Factors, Prohibited discrimination includes, What Factors of Discrimination Are, For Retaliation Allegations Only, On I engaged in EEO activity, Case No, Month Day Year, On I engaged in EEO activity, Case No, Month Day Year, C Description of IncidentActivity, and On Year segment.

The program will require details to effortlessly submit the box PS Form A March Page of.

Indicate the rights and obligations of the parties in the section D Comparisons, Explain why based on the factors, Name of Employee, Factors that describe the employee, was treated differently than I when, Name of Employee, Factors that describe the employee, was treated differently than I when, Name of Employee, Factors that describe the employee, and was treated differently than I when.

End up by reading the following fields and preparing them as required: E Officials Responsible for Actions, List the names of the officials, a Name, c Office, a Name, c Office, b Title, d Grade Level, b Title, d Grade Level, Retaliation Allegations Only, Yes, If yes explain how the officials, F Resolution, and What are you seeking as a.

Step 3: Choose the Done button to save the file. Then it is ready for transfer to your device.

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Ps Form 2564 A – Fill Out and Use This PDF

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