Form Doj-Jmd-Fs-2 Investigation Report Form Page 2
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4Employee Name: ___________________________
Was employee told of overpayment? _______
If Yes, provide date(s) of verbal and/or written notification(s): ___________________________
Did employee know of overpayment without being told? _______
Did employee report it (if so, indicate to whom)? ______________________________________
If Yes, was it promptly reported to the Servicing Personnel Office by employee or employee’s
supervisor? _________
Indicate response to employee (e.g., Did supv or SPO agree that there was an error?):
______________________________________________________________________________
Personnel Office’s statement regarding whether there was any indication of deceit,
misrepresentation, fault, or lack of good faith on the employee’s or requester’s part:
______________________________________________________________________________
Personnel Office’s statement as to whether corrective action is being taken to prevent the
occurrence of similar erroneous payments:
______________________________________________________________________________
Is the employee separated or deceased? ______
If No, does the employee have a “Not to Exceed” (NTE) appointment date? ________
If Yes, provide the NTE date: _________
Enter the Following Employee Facts ->
Federal Service Computation Date:_______________________________
Last Promotion Effective:_______________________________________
Within Grade or Quality Step Increase Effective, if pertinent:____________________
Required waiting period for WGI:_____________________
Pay Plan, Grade, Step at time of error:______________________________________
Occupation/Job Title at time of error:_______________________________________
FEGLI or Health Benefits info, if pertinent:__________________________________
Did pay fluctuate considerably for several pay periods before the error?____________
Was there a substantial increase in pay when the error occurred?_________________
Check the items that were submitted with the waiver request form:
☐ Notifications of Personnel Action (SF-50)
☐ Certified Income & Expense Statement
☐ Earnings & Leave Statement
☐ Copy of bill (Employee Notice)
☐ Time & Attendance Report
☐ Schedule of Erroneous Payment
☐ Employee benefit election form
☐ Notice of pay entitlement or pay cap
☐ Job Vacancy Announcement
☐ Other, as specified:
☐ Allowance Agreement
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Parent category: Business