Equal Employment Opportunity (Eeo) Policy And Program Administration Form Sample (Page 37 of 54) in pdf

Equal Employment Opportunity (Eeo) Policy And Program Administration Form Sample Page 37

VA MEDICAL CENTER

POLICY MEMORANDUM 00-304

BRONX, NEW YORK 10468

July 31, 2003

Privacy Act Statement

Section 6311 of title 5, United States Code, authorizes collection of this information. The primary use of this information is by management and your payroll office to approve and

record your use of leave. Additional disclosures of the information may be: To the Department of Labor when processing a claim for compensation regarding a job connected injury or

illness; to a State unemployment compensation office regarding a claim; to Federal Life Insurance or Health Benefits carriers regarding a claim; to a Federal, State, or local law

enforcement agency when your agency becomes aware of a violation or possible violation of civil or criminal law; to a Federal agency when conducting an investigation for

employment or security reasons; to the Office of Personnel Management or the General Accounting Office when the information is required for evaluation of leave administration; or

the General Services Administration in connection with its responsibilities for records management.

Public Law 104-134 (April 26, 1996) requires that any person doing business with the Federal Government furnish a social security number or tax identification number. This is an

amendment to title 31, Section 7701. Furnishing the social security number, as well as other data, is voluntary, but failure to do so may delay or prevent action on the application. If

your agency uses the information furnished on this form for purposes other than those indicated above, it may provide you with an additional statement reflecting those purposes

Office of Personnel Management

OPM FORM 71 (Rev. 12-97)

5 CFR 630

June 2001