The U.S. Equal Employment Opportunity Commission

Appendix E EEO-MD-110


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
DISCRIMINATORY EVENT] the following occurred: [IDENTIFY
ALLEGED DISCRIMINATORY EVENT] ___________________________________
___________________________________________________________.  The
purpose of this letter is to set out the terms of the informal

[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


___________________    _____________________    _________________

EEO Counselor          Agency Official          Aggrieved Person

Date:                  Date:                     Date:

This page was last modified on November 8, 1999.

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