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Section 1. General Information
Component: ___________________________________________
Component Contact: __________________________________
Contact Phone Number: _________________________________
Date of Report: ______________________________________
Report Covers Fiscal Year (FY): ______________________
Section 2. Information on Each Repayment
| Purpose-- Recruitment or Retention |
Amount Repaid in FY |
Amount to be Repaid in Future FYs |
Position Title & Job Series |
Pay Plan & Grade |
Geographic Area (City/State) |
Service Agreement in Months |
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Section 3. Narrative Discussion (Description of situations in which repayment was made, the effectiveness of the repayment authority, and recommendations for change.)
Note: As required by Chapter 2-12, Paragraph C.3. of DOJ Order 1200.1, Bureaus must submit this report by each November 15 to:
Director, JMD Personnel Staff
U.S. Department of Justice
1331 Pennsylvania Avenue, NW
Room 1110
Washington, DC 20530
revised: November 2001
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