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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 

AgencySecond Level ComponentAddressCityStateZip Code (xxxxx)Agency Code (xxxx)FIPS Code
(xxxx)
        

Part B - Total Employment 

Total EmploymentPermanent WorkforceTemporary WorkforceTotal Workforce
Number of Employees   

Part C.1 - Head of Agency and Head of Agency Designee 

Agency LeadershipNameTitle
Head of Agency  
Head of Agency Designee  

Part C.2 - Agency Official(s) Responsible for Oversight of EEO Program(s) 

EEO Program StaffNameTitleOccupational 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 ComponentCityStateCountry (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 NoComments
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 NoComments
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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