Fillable Da Form 7509 - Information Inquiry Summary printable pdf download

Da Form 7509 - Information Inquiry Summary

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1. DATE OF INITIAL CONTACT

INFORMATION INQUIRY SUMMARY

(YYYYMMDD)

For use of this form, see AR 690-600; the proponent agency is OSA

PRIVACY ACT STATEMENT (5 U.S.C. §552a)

Public Law 92-261

AUTHORITY:

Used for processing of complaints of discrimination because of race, color, religion, sex, national origin, age,

PRINCIPAL PURPOSE:

physical or mental disability, and/or reprisal by Department of the Army civilian employees, former employees,

applicants for employment, and some contract employees.

ROUTINE USES:

Information will be used (a) as a data source for complaint information for production of summary descriptive

statistics and analytical studies of complaints processing and resolution efforts (b) to respond to general requests

for information under the Freedom of Information Act; (c) to respond to requests from legitimate outside

individuals or agencies (White House, Congress, Equal Employment Opportunity Commission) regarding the status

of an EEO complaint or appeal; or (d) to adjudicate complaint or appeal.

DISCLOSURE:

Voluntary, however, failure to complete all appropriate portions of the form may lead to delay in processing and/or

rejection of complaint on the basis of inadequate data on which to continue processing.

2. NAME

(Last, First, Middle Initial)

3. DUTY ORGANIZATION (Complete address including office symbol)

4. WORK TELEPHONE NUMBER

5. HOME TELEPHONE NUMBER

6. HOME ADDRESS

7. EEO OFFICIAL CONTACTED

8. TYPE OF CONTACT

EEO OFFICER OR STAFF MEMBER

TELEPHONIC

IN-PERSON

E-MAIL

EEO COUNSELOR

9. MATTER(s) OF CONCERN IDENTIFIED (Use additional sheets, if required.)

10. CONTACT SUMMARY

Provided general information regarding EEO complaint processing, emphasizing the 45-calendar day prescribed time limitation

for Initiating the EEO complaint process and right to representation during the EEO process, including the pre-complaint intake interview.

OTHER(Explain)

11. PRINTED NAME OF EEO OFFICIAL

12. SIGNATURE OF EEO OFFICIAL

13. DATE (YYYYMMDD)

14. PRINTED NAME OF INDIVIDUAL

15. SIGNATURE OF INDIVIDUAL (If available)

16. DATE (YYYYMMDD)

DA FORM 7509, FEB 2004

APD LC v1.01

Da Form 7509 - Information Inquiry Summary

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