OMB control number

EEO Complaint Forms

OMB 1505-0262 · TREAS/DO.

OMB 1505-0262

Treasury employees, former employees, and applicants for employment may contact the Department’s EEO Offices if they believe they have been subjected to discrimination based on race, color, sex (includes sexual harassment, sexual orientation and gender identity), national origin, religion, disability, age (40 or over), parental status, protected genetic information, or retaliation. A Treasury staff member responsible for obtaining information regarding the claim(s) of discrimination will record on a Report of Counseling (Intake) Form the aggrieved party’s (“the aggrieved”) personal information, i.e., name, address, telephone numbers, etc., as well as the bases and issues raised by the aggrieved. Thereafter, an EEO Counselor will be assigned, who will review the information on the Report of Counseling (Intake) Form and contact the aggrieved to schedule an initial interview. This interview may include, but is not limited to: verifying the information on the Intake Form, clearly defining the scope of the issues, reviewing the rights and responsibilities of the aggrieved and the agency during the EEO complaint process including the right to representation and anonymity, the applicable time frames, the option to extend the counseling process, the right to choose between Alternative Dispute Resolution (ADR) and EEO Counseling, and the overall stages of the complaint process.

The latest form for EEO Complaint Forms expires 2028-09-30 and is listed under ICR 202504-1505-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form TD F 63-03.5 Formal Complaint Form	Form and Instruction
Form TD F 63-03.5 Formal Complaint Form	Form and Instruction
Form TD F 62-03.10 Class Complaint	Form and Instruction
Form TD F 62-03.10 Class Complaint	Form and Instruction
Form TD F 32.03-9 Notice of Withdrawal from Participation in the EEO Pre-Complaint Process	Form and Instruction
Form TD F 32.03-9 Notice of Withdrawal from Participation in the EEO Pre-Complaint Process	Form and Instruction
Form TD F 62-03.8 Notice of Right to FIle	Form and Instruction
Form TD F 62-03.8 Notice of Right to FIle	Form and Instruction
Form TD F 62.03.7 Notice of Rights and Responsabilities	Form and Instruction
Form TD F 62.03.7 Notice of Rights and Responsabilities	Form and Instruction
Form TD F 62-03.6 Agreement to Extend Counseling	Form and Instruction
Form TD F 62-03.6 Agreement to Extend Counseling	Form and Instruction
Form TD F 62-03.4 Agreement to Extend Counseling to Participate in Mediation	Form and Instruction
Form TD F 62-03.4 Agreement to Extend Counseling to Participate in Mediation	Form and Instruction
Form TD F 62-03.2 Designation of Represenative	Form and Instruction
Form TD F 62-03.2 Designation of Represenative	Form and Instruction
Form TD F 62-03.1 EEO Informal Report of Counseling	Form and Instruction
Form TD F 62-03.1 EEO Informal Report of Counseling	Form and Instruction
Form TD F 62-03.11 ADR Election Form	Form
Form TD F 62-03.11 ADR Election Form	Form
PC_202504-1505-001_071525_062057_1.pdf	Public Comments
Suzanne Marks Comment - EEO Forms.pdf	Public Comments
Sue Larson Comment - EEO Forms.pdf	Public Comments
NELA Comments on Treasury EEO Complaint Form Changes (6.26.2025).pdf	Public Comments
Mark Regini Comment - EEO Forms.pdf	Public Comments
Marc Seawright Comment - EEO Forms.pdf	Public Comments
JSCCO Comment - EEO Forms.pdf	Public Comments
Holly Tippett Comment - EEO Forms.pdf	Public Comments
Ethan Cohen Comment - EEO Forms.pdf	Public Comments
Elwen Green Comment - EEO Forms.pdf	Public Comments
Daniela Nanau Comment - EEO Forms.pdf	Public Comments
Colleen Dawson Comment - EEO Forms.pdf	Public Comments
Christen Boas Hayes Comment - EEO Forms.pdf	Public Comments
12 Members of Congress - Final Treasury Letter re EEO Forms.pdf	Public Comments
1505-0262 Supporting Statement 2025-09-29.docx	Supporting Statement A
1505-0262 SS OCRE EEO Forms 2025-06.docx	Supporting Statement A
Formal Complaint Form	Form and Instruction
Formal Complaint Form	Form and Instruction
Class Complaint	Form and Instruction
Class Complaint	Form and Instruction
Notice of Withdrawal from Participation in the EEO Pre-Complaint Process	Form and Instruction
Notice of Withdrawal from Participation in the EEO Pre-Complaint Process	Form and Instruction
Notice of Right to FIle	Form and Instruction
Notice of Right to FIle	Form and Instruction
Notice of Rights and Responsabilities	Form and Instruction
Notice of Rights and Responsabilities	Form and Instruction
Agreement to Extend Counseling	Form and Instruction
Agreement to Extend Counseling	Form and Instruction
Agreement to Extend Counseling to Participate in Mediation	Form and Instruction
Agreement to Extend Counseling to Participate in Mediation	Form and Instruction
Designation of Represenative	Form and Instruction
Designation of Represenative	Form and Instruction
EEO Informal Report of Counseling	Form and Instruction
EEO Informal Report of Counseling	Form and Instruction
ADR Election Form	Form
ADR Election Form	Form

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202504-1505-001	Revision of a currently approved collection	2025-06-30
202208-1505-002	No material or nonsubstantive change to a currently approved collection	2022-08-11	Approved without change
202207-1505-002	No material or nonsubstantive change to a currently approved collection	2022-07-15	Approved without change
202203-1505-006	Extension without change of a currently approved collection	2022-03-31	Approved without change
201705-1505-001	New collection (Request for a new OMB Control Number)	2018-03-26	Approved with change

OMB Details

ADR Election Form

Federal Enterprise Architecture: Workforce Management - Labor Rights Management

Information collection instruments
Form	Name	Electronic access	Type
Form TD F 62-03.11	ADR Election Form	Fillable Fileable	Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.