MD-715 Parts A Through E
EEOC Form
U.S. Equal Employment Opportunity Commission
FEDERAL AGENCY ANNUAL EEO PROGRAM STATUS REPORT
Part A - Department or Agency Identifying Information
| Agency | Second Level Component | Address | City | State | Zip Code (xxxxx) | Agency Code (xxxx) | FIPS Code (xxxx) |
|---|---|---|---|---|---|---|---|
Part B - Total Employment
| Total Employment | Permanent Workforce | Temporary Workforce | Total Workforce |
|---|---|---|---|
| Number of Employees |
Part C.1 - Head of Agency and Head of Agency Designee
| Agency Leadership | Name | Title |
|---|---|---|
| Head of Agency | ||
| Head of Agency Designee |
Part C.2 - Agency Official(s) Responsible for Oversight of EEO Program(s)
| EEO Program Staff | Name | Title | Occupational Series (xxxx) | Pay Plan and Grade (xx-xx) | Phone Number (xxx-xxx-xxxx) | Email Address |
|---|---|---|---|---|---|---|
| Principal EEO Director/Official | ||||||
| Affirmative Employment Program Manager | ||||||
| Complaint Processing Program Manager | ||||||
| Diversity & Inclusion Officer | ||||||
| Hispanic Program Manager (SEPM) | ||||||
| Women's Program Manager (SEPM) | ||||||
| Disability Program Manager (SEPM) | ||||||
| Special Placement Program Coordinator (Individuals with Disabilities) | ||||||
| Reasonable Accommodation Program Manager | ||||||
| Anti-Harassment Program Manager | ||||||
| ADR Program Manager | ||||||
| Compliance Manager | ||||||
| Principal MD-715 Preparer | ||||||
| Other EEO Staff |
Part D.1 - List of Subordinate Components Covered in this Report
Please identify the subordinate components within the agency (e.g., bureaus, regions, etc.).
◻ If the agency does not have any subordinate components, please check the box.
| Subordinate Component | City | State | Country (Optional) | Agency Code (xxxx) | FIPS Codes (xxxxx) |
|---|---|---|---|---|---|
Part D.2 - Mandatory and Optional Documents for this Report
In the table below, the agency must submit these documents with its MD-715 report.
| Did the agency submit the following mandatory documents? | Please respond Yes or No | Comments |
|---|---|---|
| Organizational Chart | ||
| EEO Policy Statement | ||
| Strategic Plan | ||
| Anti-Harassment Policy and Procedures | ||
| Reasonable Accommodation Procedures | ||
| Personal Assistance Services Procedures | ||
| Alternative Dispute Resolution Procedures |
In the table below, the agency may decide whether to submit these documents with its MD-715 report.
| Did the agency submit the following optional documents? | Please respond Yes or No | Comments |
|---|---|---|
| Federal Equal Opportunity Recruitment Program (FEORP) Report | ||
| Disabled Veterans Affirmative Action Program (DVAAP) Report | ||
| Operational Plan for Increasing Employment of Individuals with Disabilities under Executive Order 13548 | ||
| Diversity and Inclusion Plan under Executive Order 13583 | ||
| Diversity Policy Statement | ||
| Human Capital Strategic Plan | ||
| EEO Strategic Plan | ||
| Results from most recent Federal Employee Viewpoint Survey or Annual Employee Survey |
Part E - Executive Summary
All agencies must complete Part E.1; however, only agencies with 199 or fewer employees in permanent FT/PT appointments are required to complete Part E.2 to E.5. Agencies with 200 or more employees in permanent FT/PT appointments have the option to Part E.2 to E.5.
Part E.1 - Executive Summary: Mission
Part E.2 - Executive Summary: Essential Element A - F
Part E.3 - Executive Summary: Workforce Analyses
Part E.4 - Executive Summary: Accomplishments
Part E.5 - Executive Summary: Planned Activities