OMB Number 1105-00 Request for Consideration

OMB Number 1105-0086. Expires xx/xx/xxxx

REQUEST FOR CONSIDERATION
(For New Participants or Prior Participants Who Must Re-Compete)
ATTORNEY STUDENT LOAN REPAYMENT INCENTIVE
U.S. DEPARTMENT OF JUSTICE
y OARM strongly recommends that you read the ASLRP Policy and complete the ASLRP
Eligibility Worksheet before beginning the request process.
y Requests must be TYPED or FORM-FILLED - not hand-written, except for initials and
signatures.
y It is your responsibility to ensure your request is accurate, complete, properly
assembled, and timely. OARM will not process late or incomplete requests.
ASSEMBLY AND SUBMISSION REQUIREMENTS:
Submit two request packets(one for OARM, one for your component), assembled as described
below, to your organization's ASLRP point of contact. (See Where To Submit Your Request at
http://www.usdoj.gov/oarm/aslrp/poc.htm . Do not attach performance evaluations or other documents.
A. Packet 1 - OARM Packet : Submit one copy of Part 1 with Tabs as specified below.
Submit 6 copies of Part 2, with resume attached as specified below.
y Part 1: Attorney and Loan Information (One copy)
o Tab A : One current copy of each lender's statement of account status, 2009
payment history, and current balance on each loan. If loans were consolidated,
documentation showing the original loans were qualifying loans
o Tab B : Your signed Service Agreement (original signature)
o Tab C : (Optional)Statistical Data on Race, Ethnicity, National Origin, and
Gender
y Part 2: Justification (Six copies)
o Attach one copy of your current resume to each justification.
B. Packet 2 -- Component/Office/Bureau/Division (or equivalent) Packet: Submit one copy
of Part 1, one copy of Part 2 (your justification and resume), and one copy of your signed
Service Agreement.

OARM WILL NOT PROCESS HANDWRITTEN OR INCOMPLETE REQUESTS, ASSEMBLE
TABS, MAKE COPIES, OR ACCEPT MISSING DOCUMENTS SUBMITTED SEPARATELY
Effect of Non-disclosure
Your submission of this Request for Consideration is voluntary; however, if the Request is
submitted, omission of significant information requested would preclude continued processing to
determine whether receive an incentive benefit.

REQUEST FOR CONSIDERATION
ATTORNEY STUDENT LOAN REPAYMENT INCENTIVE, FY 2010

Part 1: Attorney and Student Loan Information.
(Privacy Act statement follows Part 2)

Attorney Information.
1.

Name:

2.

DOJ Supervisor's
Name and work phone:

3

4a

SSN:

DOJ Component and
Office of Assignment
(e.g., Civil Division/Federal
Programs)
Current Employees only:
mm/dd/yy

Indicate the date you entered on duty

4b
4c

Current Employees only:
Were you previously approved for ASLRP (e.g.
received funding)?
Current Employees only:

Yes
No
Years received:

If you received prior ASLRP funding, list all years received and expiration
date of your most recent service obligation associated with the ASLRP.

End date of last service obligation:

“If a prior ASLRP recipient, are you performing the last year of your service
obligation between June 2009 - July 10?

Yes

No

“If performing a current service obligation, were you in a leave without pay
status or in any other non-pay status between June 2009 - July 2010?”

Yes

No

If “yes”, was the absence due to uniformed service or compensable injury?

Yes

No

If “yes,” ensure a copy of orders or other documentation is attached. No
extension of the current service obligation is required. If “no,” list the
dates of absences below, then correct component records to extend the
existing service obligation completion date by the total amount speng in a
non-pay status.

4d

4e
5.

Incoming attorneys:
Indicate the date you
are scheduled to enter
on duty.

Note: If after September 30, 2010, request
must be approved by the Program
Administration Panel as an exception to
policy as it crosses into the next fiscal
year and thus affects availability of
funding.

Incoming attorneys
only:

Are you an incoming Honors
Program attorney?

mm/dd/yy
Yes
No

Annual base salary
$
( as of December 31,
Attorneys paid under Title 5 (i.e., GS attorneys) can determine their
2009. Do not
include locality pay.) base salary for December 2009 by selecting the General Schedule

and Locality Pay Tables at www.opm.gov/oca/09tables/. Attorneys
paid under Title 23 (i.e., Assistant U.S. Attorneys) can determine their
2009 base salary by consulting their Human Relations staffs.

6.

Type of Appointment
and, if term, end date

(e.g., permanent;
temporary leading to
permanent; or term)
Consult your HR staff for
assistance if needed.

7.

If you have not yet
entered on duty, are
you currently employed
by another Federal
agency? (Federal Judicial
Law Clerks are not
considered permanently
employed by another
Federal agency).

8.

Mailing Addresses

Attorneys holding term appointments with less than three years
remaining before expiration are not eligible. Many new hires hold 14month temporary appointments that lead to permanent appointments
pending adjudication of background investigations (e.g., Honors
Program attorneys except those in 1-2 year fellowships/clerkships).

List current Federal agency, and supervisor's name
and telephone number.

YES

NO
Work

Home

9.

Work Telephone
Numbers

10.

Fax number

11.

E-Mail Addresses

Student

Loan

Work
Home

Information:

y If loans were consolidated, you must provide documentation from the lender showing
that the original loans were qualifying loans.
y If you consolidated your loans with a spouse's loans, you must segregate your qualifying
loans and provide supporting documentation for your loans. The burden of
explaining/clarifying your loan information so that it is easily understood rests on you.
Complete the block below for each of your existing, qualifying student loans. List them in the order you
wish the incentive payments to be credited if you are selected for ASLRP. See the ASLRP policy for
information on which loans qualify. If you have more than one outstanding loan, use the loan information
continuation page to continue. Note that one block must be completed for each loan, even if all loans are
with the same lender. Provide a letter or statement (dated within 45 days prior to the date this request is
submitted) from each lender or loan servicing organization for each loan indicating that the loan is
current and in good standing, with your payment history for 2009, and reflecting the current balance. A
monthly payment statement or cancelled check will not suffice. An Internet account printout containing the
required information is acceptable.

12. Number of qualifying Federal student loans:
13. My total qualifying Federal student loan indebtedness total is:

$

(Do not include information about private loans that are not federally guaranteed.)
14. My 2009 annual payments on qualifying Federal student loans was: $
(Calculate this based on the actual amount you paid from January through December of 2009.
If you are a recent law school graduate whose loan payments were tolled for a part of that year,
or a current law student who is not yet making payments, please initial the block below).
I am a recent law school graduate. My qualifying Federal student loan repayments
were tolled for all or part of the most recent calendar year.

15. List the source and amount of any other student loan repayment benefits you
receive (e.g., from a law school) in the space below. If none, so state.
16. If you received a student loan repayment incentive from another Federal agency
prior to entering on duty, enter the total amount you received (gross payment prior to
withholdings) and the name of the agency here:
$

Loan 1

Agency:
Amount of outstanding balance:

$

Effective date of above
outstanding balance:
Loan holder/servicing organization
(complete name, payment address,
telephone number)
(Remember to attach a statement from
the lender showing balance, payments,
and account status.)
Loan identification number
Type of Loan (e.g., Stafford, Direct)
Payment amount and frequency
(e.g., monthly/quarterly/annually)

$

per

Due date of the next payment
Amount you personally paid
between Jan 1 and Dec 31, 2009

$

Amount due in 2010

$

Attach continuation pages as needed to document each qualifying Federal loan.

TAB C (Optional)
SSN:

NAME:

STATISTICAL DATA ON RACE, ETHNICITY, NATIONAL ORIGIN AND GENDER
y Provision of this information is voluntary.
y You may elect to provide all, part, or none of the requested information.
The following information is being collected for statistical purposes only. The provisions
of 5 C.F.R. § 537.105(d) require the Department to adhere to merit systems principles.
This page will be separated from your request by OARM prior to forwarding to the
Program Administration Panel for consideration.
You will be instructed to submit this page as a separate tab (Tab C) to your request. If
you elect not to provide any of this information, simply omit Tab C from your request
packet.
Gender:

Male

Female

Ethnicity:
Hispanic or Latino - a person of Cuban, Mexican, Puerto Rican, South or Central American,
or other Spanish culture or origin, regardless of race
Not Hispanic or Latino

Race (Check all that apply):
American Indian or Alaska Native - a person having origins in any of the original peoples of
North or South America (including Central America), and who maintains tribal affiliation or
community attachment.
Asian - a person having origins in any of the original peoples of the Far east, Southeast
Asia, or the Indian subcontinent, including, e.g., Cambodia, China, India, Japan, Korea,
Malaysia. Pakistan, the Philippine Islands, Thailand, or Vietnam.
Black or African American - a person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander - a person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White - a person having origins in any of the original peoples of Europe, the Middle East, or
North Africa.

NAME:

SSN:

Please read the certification block carefully before signing and dating. Review the ASLRP policy
(http://www.usdoj.gov/oarm/aslrp/poliy.htm) for clarification if you do not understand the terms of
this certification. If you need further assistance, contact OARM.

Certification:
I certify that all the information I provided for ASLRP consideration is true and correct, including data
provided in the Justification. I further certify that I am not in default on any qualifying Federal student
loan, whether or not listed here. As part of this certification, I attest that:

y I have read and understand the Attorney Student Loan Repayment Program policy.
y I understand that the ASLRP is an agency incentive program, not an entitlement.
y I understand that ASLRP awards are subject to tax and withholdings, which are deducted before
payment is issued to the loan holder.

y I am aware of the eligibility requirements, the "matching funds" provisions, and the requirement to
continue making personal loan repayments.

y I understand that if selected, the Department does not guarantee future incentive payments
y

y
y
y

beyond the current fiscal year, and that all payments are subject to the availability of funds as
determined solely in the discretion of the Department of Justice.
I understand that acceptance of ASLRP funding triggers a three-year service obligation
specifically to the Department of Justice and not to federal service in general, and that all
payments issued on my behalf (pre-tax amounts) may be recouped if I fail to complete my service
obligation.
I acknowledge that periods of leave without pay or other periods in which I am not in a pay status
(except absence due to uniformed service or compensable injury) do not count toward completion
of my service obligation.
I certify that no performance, misconduct or discipline issues render me ineligible for this
program.
I understand that I may be subject to administrative and/or disciplinary action, including but not
limited to termination of the loan repayment incentive, if I provide false information.

Signature
Date

Part 2: Justification.

Prepare a written justification as described below.

The Program Administration Panel will carefully consider your responses to the information
requested below. Please follow the categories in the order specified. An appropriate response
will be succinct, well organized, and relevant to the specific category. There are suggested
areas of interest listed in italics under some of the categories. You are not required to address
each area of interest - they are suggestions intended to identify the relevant topics of interest
for that category.
1. Education: Please summarize your educational background.
Areas of interest include law school academic background, law review, competitive moot court
(e.g., Jessup Cup, etc - not mandatory first-year moot court), graduate law degrees, other
advanced degrees, and continued professional education or training. Please highlight any
significant honors or achievements. Do not address judicial clerkships.
2. High or Unique Qualifications Relevant to DOJ Duties - or - Special Need of the Department:
y You must justify ASLRP selection based on one or both of these elements.
y You may articulate how you meet component qualifications (posted on Appendix A)
for your assigned component. If there is nothing for your component listed on
Appendix A or you do not meet the listed qualifications, then you must provide a
justification sufficient for the Department to find that you meet one of the elements
above.
y You must explain how your qualifications or your ability to meet a special Department
need impact on your current duties.
y Your response to this section should be limited to 1 page.
Areas of interest include:
a. Whether you meet specific component-identified qualifications for the position to
which you are currently assigned (e.g., membership in specialty bar (e.g., Patent Bar) or other
professional qualifications relating to attorney's duties (e.g., CPA, Patent Agent), undergraduate
or advanced degrees in fields relevant to DOJ component's practice, foreign language fluency
(e.g., must possess professional proficiency in the spoken and written language and be able to
conduct legal business associated with your DOJ position, etc.) See Appendix A for a listing of
component-identified qualifications. (Please note, you must actually be assigned to the
component in order to justify ASLRP using Appendix A qualifications. For example, do not base
your justification on qualifications listed by the Antitrust Division if you are assigned to the
Criminal Division).
b. Judicial Clerkship (but only if relevant to your current duties).
c. Other knowledge, skills, experience, education, prior employment, or training that
contributes to your effectiveness as a DOJ attorney.
d. Assignment to a component-designated "hard-to-fill" location (also listed on Appendix
A). You must actually be assigned to the listing component and to the geographic location.
e. The manner in which you contribute directly to accomplishment of one or more DOJ Strategic
Goals and Objectives (see www.justice.gov/jmd/mps/strategic2007-2012/index.html)
1. Prevent Terrorism and Promote the Nation's Security (see www.justice.gov/jmd/mps/
strategic2007-2012/goal1.pdf)
2. Prevent Crime, Enforce Federal Laws, and Represent the Rights and Interests of the
American People (see www.justice.gov/jmd/mps/strategic2007-2012/goal2.pdf)

3. Ensure the Fair and Efficient Administration of Justice (see www.justice.gov/jmd/mps/
strategic2007-2012/goal3.pdf)
3. Demonstrated Potential Based on Objective Accomplishments: This area focuses on your
overall potential as demonstrated by activities within the past 12 months. Honors Program
attorneys and lateral hires who have not yet entered on duty with the Department may base
their responses on their current or past employment or school environment, volunteer, public
service or leadership experiences.
Areas of interest include:
• Performance evaluations
y Ability to train or mentor others
y Pro bono or other volunteer or public service activities
y Other service to the Component or the Department (e.g., represents the component
as a public speaker, moot court judge for law school competitions, legal recruiting
activities, etc.)
y Demonstrated leadership
4. The Basis for a Determination of Recruitment or Retention Difficulty: Please articulate a
basis for a determination of the degree of recruitment or retention difficulty.
y You may use factors listed in Appendix B, or other relevant factors.
y Attorneys already on duty with the Department must address the extent to which
their departure would affect DOJ's ability to carry out an activity or perform a
mission-essential function and their likelihood of leaving the Department for
employment outside the Federal service if not selected for participation.
5. Short Essay: Provide a short essay (not to exceed 1 page) discussing either the greatest
challenge you faced in pursuing your legal career or your greatest contribution to the legal
profession.

General
This information is provided pursuant to the Privacy Act of 1974 (P.L. 93-597).
Authority for Collection of Information
5 U.S.C § 5379
Purpose and Uses
The main purpose for collecting the information requested on this form is to establish the terms
under which an individual receives a student loan repayment benefit under the Attorney Student
Loan Repayment Program. The information collected will be used as a basis for payroll actions
and to identify and validate qualifying Federal student loans. Accordingly, disclosure of
identifiable information, including your Social Security Number (SSN), may be made to the
Internal Revenue Service for tax withholding purposes, the Department of Agriculture for payroll
action, and to the Department of Labor for worker compensation claims, and to lending or
educational institutions to identify and validate qualifying Federal student loans. This
information may also be used by the Department of Justice for other lawful purposes including
law enforcement and in the event of litigation. In addition, these records, or information therein,
may also be used within the Department of Justice for study purposes, such as projection of
staffing needs, and/or creation of non-identifiable statistical data for reports to other Federal
agencies and Congress.
Information Regarding Disclosure of Your Social Security Account Number
Disclosure of the SSN is mandatory since it is the identifier used by the Internal Revenue
Service and for the withholding of taxes from your salary. The use of the SSN is necessary
because of the large number of present and former employees and applicants who have
identical names and birth dates, and whose identities can be distinguished only by the SSN. It
is used primarily to identify an employee's personnel, leave, and pay records and to relate one to
the other. In this regard, it is also used by the Department of Justice to locate records in order
to respond to lawful requests for information from former employers, educational institutions,
and financial or other organizations. It also may be used by the Department of Justice to
identify and validate qualifying Federal student loans. The information gathered through the use
of the number will be used only as necessary in personnel administration processes carried out
in accordance with established regulations and published notices of systems of records. The
SSN also will be used for the selection of persons to be included in statistical studies of
personnel management matters.