Appendix 12



AGREEMENT TO EXTEND 180 DAYS FOR COMPLAINT INVESTIGATION



Bureau Equal Opportunity Office

Address



Dear Equal Opportunity Officer:


This is in reference to the complaint of discrimination I filed against the Department of the Interior, Bureau/Office on (date), docket number (XXX-XX-XXX) .


I have received notice that the investigation of my complaint has not yet been completed and that it has been one hundred and eighty (180) days since my complaint was filed. I understand that I now have the right to request a hearing before an Equal Employment Opportunity Commission (EEOC), Administrative Judge (AJ), or I may allow the Bureau/Office an additional ninety (90) days to complete the investigation of my complaint. Pursuant to regulations at 29 C.F.R. 1614.108 (e):

[ ] I agree to a ninety (90) day extension for the Bureau/Office to complete the investigation of my complaint.

[ ] I do not agree to a 90-day extension to complete the investigation of my complaint. I am requesting a hearing by the EEOC, or in a mixed-case, a decision by the Director, OEO. Please advice me of the appropriate EEOC Field Office to which I should send my request.




Sincerely,





Complainant's Name Date