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  3. MD-715 Parts A Through E

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
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