Justification Memo for No Material Change

DEPARTMENT OF THE TREASURY
WASHINGTON D.C. 20220

August 9, 2022

MEMORANDUM FOR MELODY BRASWELL, PRA CLEARANCE OFFICER

FROM:

SUBJECT:

Clarissa D. Lara
Clarissa Lara
EEO Specialist, Office of Civil Rights and EEO

Digitally signed by Clarissa D.
Lara
Date: 2022.08.09 16:20:06
-04'00'

Minor Revisions to EEO OMB No. 1505-0262
3/31/2022 Approved Forms

Your office submitted an ICR for extension of OMB No. 1505-0262 on 03/31/2022 and the ten
(10) forms were approved through 06/30/2025. However, since the forms were approved, our
office has undergone a reorganization and a new policy was issued regarding gender neutrality
text. The forms have been updated to reflect the following:
Change 1: The OMB expiration date. Each form was updated to reflect the expiration date of
6/30/2025.
Change 2: Our office name has changed as of last month and our new office name is Office of
Civil Rights and EEO (OCRE). All the forms were updated to reflect our new office name.
Change 3: Due to our office name change, the logos on the forms were replaced with a
Department of Treasury seal.
Change 4: We remove any gender specific references (he/she or his/her) to adhere to the
Department’s Gender Inclusive Language Policy.
If you have any questions about the minor revisions made, please feel free to contact me at 202257-2981or [email protected]. Thank you.
ATTACHMENTS
1. ADR Election TD F 62-03.11 2022
2. Agreement to Extend Counseling with Mediation TD F 62-03.4 2022
3. Agreement to Extend Counseling without Mediation TD F 62-03.6 2022
4. Designation of Representative and Limited Power of Attorney TD F 62-03.2 2022 rvs
5. Individual Formal Complaint Form TD F 62-03.5 2022
6. Class Complaint Form TD F 62-03.10 2022
7. Notice of Rights and Responsibility Final TD F 62-03.7 2022 rvs 2
8. Notice of Right to File Final TD F 62-03.8 2022 rvs 2
9. Report of Counseling 3 Final TD F 62-03.1 2022 rvs 2
10. Notice of Withdrawal TD F 62-03.2 2022 rvs

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