The PS Form 2564 C plays a crucial role in the processes of the U.S. Postal Service, specifically in the sphere of addressing complaints of discrimination. This form is a formal document that allows an individual—be it an employee of the Postal Service or someone who has a grievance related to the organization—to voluntarily withdraw their request for Equal Employment Opportunity (EEO) counseling or their formal EEO complaint entirely or to withdraw specific allegations. Its use underscores the importance of the complainant's understanding that, by withdrawing their complaint or specific allegations, they are waiving their rights to pursue any further appeal regarding these matters through the EEO process. Moreover, the form includes a statement ensuring that the withdrawal has not been influenced by threat, coercion, intimidation, promise, or inducement, safeguarding the integrity of the decision to withdraw. The Privacy Act Notice embedded in the form explains the legal basis for collecting the information provided by complainants, the uses of this information, and the circumstances under which it might be disclosed. These disclosures underline the commitment to transparency and the protection of personal data within the processes outlined by laws and regulations including the Equal Employment Opportunity Act of 1972, the Age Discrimination in Employment Act of 1967, the Rehabilitation Act of 1973, and various executive orders. By encapsulating these elements, the PS Form 2564 C not only facilitates the withdrawal process but also ensures the rights and privacy of individuals are respected throughout.
| Question | Answer |
|---|---|
| Form Name | PS Form 2564-C |
| Form Length | 1 pages |
| Fillable? | Yes |
| Fillable fields | 20 |
| Avg. time to fill out | 4 min 19 sec |
| Other names | 1973, suitability, 2000e-16, 633a |
U.S. Postal Service
Withdrawal of Complaint of Discrimination
Case No.
I, ___________________________________________________________, do hereby voluntarily withdraw:
my request for EEO counseling or my formal EEO complaint in its entirety.
the following allegation(s) ONLY:
I fully understand that by withdrawing the complaint or allegation(s) I have withdrawn, I am waiving my rights to any further appeal of this allegation(s) through the EEO process. I further stipulate that my withdrawal did not result from threat, coercion, intimidation, promise or inducement.
Privacy Act Notice
Privacy Act Notice. The collection of this information is authorized by the Equal Employment Opportunity Act of 1972; 42 U.S.C. §
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.
Signature of Claimant
Date
PS Form