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Management Directive 110

Appendix F EEO-MD-110
SAMPLE RESOLUTION Agreement

Aggrieved Person's Name
Aggrieved Person's Address

RE: Resolution of EEO Dispute

Dear [Aggrieved Person]:

This refers to the dispute which you first discussed with me on [DATE] when you alleged
discrimination because of [IDENTIFY BASIS OF DISCRIMINATION] when on [IDENTIFY
DATE OF ALLEGED DISCRIMINATORY EVENT]
the following occurred: [IDENTIFY
ALLEGED]_________________________________________________________________
_______________________________________________________________________. The
purpose of this letter is to set out the terms of the informal resolution.

[INSERT TERMS OF RESOLUTION] __________________________________________
_______________________________________________________________________.

If you believe the agency has not complied with the terms of the informal resolution, you may,
under 29 C.F.R. § 1614.504, notify the Director of Equal Employment Opportunity in writing
within 30 days of the date of the alleged violation, requesting that the terms of the informal
agreement be specifically implemented. Alternatively, you may request that the claim be
reinstated for further processing from the point processing ceased.

The agency has signed the terms of the resolution as indicated by the signature of the agency
official. Your signature and date below will verify your receipt of this letter and will signify
your agreement with the terms of the informal resolution of this dispute as set out above.
Enclosed is a duplicate copy of this letter. Please date and sign the original and the copy in the
spaces provided and return the copy to me for inclusion in the counseling file. I will send a
signed copy to the agency. You may keep the original.

Sincerely,

_________________________________________
EEO Counselor
______________
Date
_________________________________________
Agency Official
______________
Date
_________________________________________
Aggrieved Person
______________
Date

Note: Be sure any agreement is put through the proper channels to ensure the agreement is enforceable and any other rights are also written in the agreement.