Form Doj-Jmd-Fs-2 Investigation Report Form Page 4

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Employee Name: ________________________________
Do any of the following denial standards apply? If yes, indicate item number(s): ____________
There was indication of fraud, misrepresentation, fault, or lack of good faith (derived from
an act or a failure to act).
Employee received or had access via the Internet comprehensible Earnings & Leave
Statements and/or T&A Reports, yet was paid for more hours in a pay status than his/her
Employee’s job occupation was in the area of personnel or payroll, which precluded
him/her from claiming no knowledge of the pay error.
Employee was not new to the Federal government (as reflected in his/her Federal Service
Comp Date), and the error was not of a complex nature.
Employee received a letter, memo, or notice outlining his/her pay setting, pay cap, or pay
Employee signed an agreement for an allowance, but did not fulfill the terms of such
Employee signed an election form for a benefit that was not sufficiently deducted from
his/her pay.
Employee’s leave adjustment(s) did not result in a negative leave balance at any time.
Therefore, there is no claim to waive.
Personnel Officer’s Recommendation & Reason(s) (include amount(s) recommended to be approved
and/or denied):
Amount Recommended to be Approved:
Amount Recommended to be Denied:
(Signature of Personnel Officer)
Amount Approved:
Amount Denied:
Decision Official’s Reason for Disagreement or Concurrence if Different Reason than Agency’s:
Decision Official’s Signature
Decision Official’s Title: __________________________________________
U.S. DOJ - Inv Rep Form
Form DOJ-JMD-FS-2 (06-16-03)
Authorized for Local Reproduction


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