EEOC FORM
715-01 PART A - D
U.S. Equal Employment Opportunity Commission

FEDERAL AGENCY ANNUAL EEO PROGRAM STATUS REPORT
For period covering October 1,_____ , to September 30,_____.

PART A

Department
or Agency
Identifying
Information

 1. Agency 1.
1.a. 2nd level reporting component  
1.b. 3rd level reporting component  
1.c. 4th level reporting component  
2. Address 2.
3. City, State, Zip Code 3.
4. CPDF Code 5. FIPS code(s) 4. 5.

PART B

Total
Employment

 1. Enter total number of permanent full-time and part-time employees

 1.
2. Enter total number of temporary employees 2.
3. Enter total number employees paid from non-appropriated funds 3.
4. TOTAL EMPLOYMENT [add lines B 1 through 3] 4.

PART C

Agency
Official(s)
Responsible
For Oversight
of EEO
Program(s)

 1. Head of Agency
Official Title		 1.
2. Agency Head Designee 2.
3. Principal EEO Director/Official
Official Title/series/grade		 3.
4. Title VII Affirmative EEO
Program Official		 4.
5. Section 501 Affirmative Action
Program Official		 5.
6. Complaint Processing Program
Manager		 6.
7. Other Responsible EEO Staff

  
 
 


EEOC FORM
715-01 PART A - D
U.S. Equal Employment Opportunity Commission

FEDERAL AGENCY ANNUAL EEO PROGRAM STATUS REPORT

PART D

List of Subordinate Components Covered in This Report

 Subordinate Component and Location (City/State) CPDF and FIPS codes
     
     
     
     
     
     
     
     
     
     
EEOC FORMS and Documents Included With This Report
*Executive Summary [FORM 715-01 PART E], that includes:   *Optional Annual Self-Assessment Checklist Against Essential Elements [FORM 715-01PART G]  
Brief paragraph describing the agency's mission and mission-related functions   *EEO Plan To Attain the Essential Elements of a Model EEO Program [FORM 715-01PART H] for each programmatic essential element requiring improvement  
Summary of results of agency's annual self-assessment against MD-715 "Essential Elements"   *EEO Plan To Eliminate Identified Barrier
[FORM 715-01 PART I] for each identified barrier		  
Summary of Analysis of Work Force Profiles including net change analysis and comparison to RCLF   *Special Program Plan for the Recruitment, Hiring, and Advancement of Individuals With Targeted Disabilities for agencies with 1,000 or more employees [FORM 715-01 PART J]  
Summary of EEO Plan objectives planned to eliminate identified barriers or correct program deficiencies   *Copy of Workforce Data Tables as necessary to support Executive Summary and/or EEO Plans  
Summary of EEO Plan action items implemented or accomplished   *Copy of data from 462 Report as necessary to support action items related to Complaint Processing Program deficiencies, ADR effectiveness, or other compliance issues.  
*Statement of Establishment of Continuing Equal Employment Opportunity Programs
[FORM 715-01 PART F]		   *Copy of Facility Accessability Survey results as necessary to support EEO Action Plan for building renovation projects  
*Copies of relevant EEO Policy Statement(s) and/or excerpts from revisions made to EEO Policy Statements   *Organizational Chart