If you are a business owner, then you have likely heard about the ps form 2564 a. This is an important document that is used for tax purposes, and it is important that you understand how to correctly complete it. In this post, we will outline the basics of what you need to know in order to complete the form correctly. Keep in mind that this is not an exhaustive list, so be sure to consult with your accountant if you have any specific questions.
Below is some data that may be useful if you are trying to learn the time it will require you to fill out ps form 2564 a and how many PDF pages it has.
| 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 | 2564 form online, 2564 form pdf, eeo form postal, form 2564 a |
U.S. Postal Service
Information for
Certified Mail No. |
Date Mail |
or Hand Delivered On |
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By (Initials) |
Case No. |
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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 |
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Email Address * |
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Employment Status (Check One) |
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Position Title |
Grade Level |
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Applicant |
Casual |
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Career |
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Pay Location |
Tour |
Duty Hours |
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Off Days (If Tour I, Show Nights Off) |
Time in Current Position |
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____ Years |
____ Months |
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Your Supervisor’s Name |
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Supervisor’s Title |
Supervisor’s Telephone No. |
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*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.: __________________________. |
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Month, Day, Year |
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2. |
On ___________________________, I engaged in EEO activity. |
Case No.: __________________________. |
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Month, Day, Year |
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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____,
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PS Form
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.
1.
(Name of Employee) |
Factor(s) that describe the employee, i.e., sex (male), National Origin (Hispanic) |
was treated differently than I when:
2.
(Name of Employee) |
Factor(s) that describe the employee, i.e., sex (male), National Origin (Hispanic) |
was treated differently than I when:
3.
(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: |
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F. Resolution
What are you seeking as a resolution to your
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, |
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(Date) |
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(Current Step) |
2. |
Filed an MSPB appeal on this issue? |
No |
Yes |
If yes, |
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(Date Appeal Filed) |
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PS Form
H. Anonymity
You have the right to remain anonymous during the
Do you desire anonymity?
No
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. §
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
Please Print Your Name Here
Your Signature
Date Signed
Please Return This Form to:
EEO Processing
P O Box 1017
Dallas, Texas
PS Form