Form Doj-Jmd-Fs-2 Investigation Report Form

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For Request to Compromise a Claim for a Debt Owed to DOJ by an Employee
(References: 31 CFR Parts 900 et al; 5 USC 5584; 31 USC 3711 )
(*Maintain Report for 6 years & 3 months)
Date Waiver Request Signed:___________
Date Request Received:_____________
Investigation Report Date*:_____________
Current Agency:______________________
Agency at time of error:_____________
Employee Name:_______________________________
Overpayment Period:____________________________________________
Bill Number:________________________
Bill Date:___________
Biweekly Error Amount: $_____________
Total Debt Amount: $______________
Date Personnel Office Notified NFC to Suspend Collection:_____________
Is Overpayment Amount $100 to 100,000?______________
☐ Pay &/or Allowances
Check Appropriate Overpayment Type:
☐ Cash Award or Quality Step Increase
☐ Understated Deductions (withholdings/benefits)
☐ Negative Leave Balance generating bill
Nature of Overpayment:__________________________________________________________
Is this error the first occurrence of this type for this employee? ___. If no, when was previous
overpayment & why did it happen again? ____________________________________________
Date Error Discovered:______________
Date Error Corrected:_______________
Office or Person who Discovered Error:___________________________________________
Was the compromise of claim form (DOJ-127 Revised) signed by the employee☐ , the
beneficiary of a deceased debtor’s estate☐ , the employing office official☐ ?


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