DA Form 7510 EEO Counselor's Report

What Is DA Form 7510?

DA Form 7510, EEO Counselor's Report is a document used for processing discrimination complaints made by Department of the Army former employees, current civilian employees, contract employees, or applicants for employment. These complaints are reported via DA Form 2590 and include cases of discrimination on the basis of national origin, age, sex, race, as well as physical or mental disability.

The latest version of the form - sometimes incorrectly referred to as the DD Form 7510 - was released by the Department of the Army (DA) in July 2010. An up-to-date DA Form 7510 fillable version is available for digital filing and download below or can be found through the Army Publishing Directorate website.

The information provided in the EEO Counselor Report is primarily used for responding to requests from legitimate agencies and individuals or to general requests according to the Freedom of Information Act. The same information may be later used for compiling descriptive statistics or analytical studies on the subject of discrimination. Disclosure of the information provided in this document is voluntary, but failure to fill in all the required data may lead to a denial or delay in processing the claim.

The DA Form 2590 (Formal Complaint of Discrimination) is a related form used to document complaints of discrimination based on national origin, religion, sex, age, physical or mental disability.

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1. DA DOCKET NUMBER
EEO COUNSELOR'S REPORT
For use of this form see AR 690-600, the proponent agency is OSA.
PRIVACY ACT STATEMENT (5 U.S.C. §552a)
Public Law 92-261
AUTHORITY:
Used for processing of complaints of discrimination because of race, color, national origin, religion, sex, age, physical
PRINCIPAL PURPOSE:
and/or mental disability, or reprisal by Department of the Army civilian employees, former employees, applicants for
employment and some contract employees.
Information will be used (a) as a data source for complaint information for production of summary descriptive statistics and
ROUTINE USES:
analytical studies of complaints processing and resolution efforts; (b) to respond to general requests for information
under the Freedom of Information Act; (c) to respond to requests from legitimate outside individuals or agencies
(White House, Congress, Equal Employment Opportunity Commission) regarding the status of a complaint or appeal; or
(d) to adjudicate complaint or appeal.
DISCLOSURE:
Voluntary, however, failure to complete all appropriate portions of this form may lead to delay in processing and/or rejection
of complaint on the basis of inadequate data on which to continue processing.
SECTION l - PRE-COMPLAINT INTAKE INTERVIEW
2. NAME OF AGGRIEVED
3. JOB TITLE
(Print-Last, First, Middle Initial)
4. PAY PLAN/SERIES/
5. DUTY ORGANIZATION
(Complete address including office symbol)
GRADE
6. WORK TELEPHONE
7. HOME TELEPHONE
8. HOME ADDRESS
10. 45
TH
CALENDAR DAY
11. REASON FOR DELAYED CONTACT BEYOND 45 DAYS, IF APPLICABLE
9. DATE OF ALLEGED
AFTER EVENT
DISCRIMINATORY ACTION
(YYYYMMDD)
(YYYYMMDD)
13. 30
TH
CALENDAR DAY
14. 90
TH
CALENDAR DAY AFTER
12. DATE OF INITIAL
15. DATE COUNSELING
AFTER INITIAL CONTACT WITH
INITIAL CONTACT WITH EEO OFFICIAL
CONTACT WITH EEO
EXTENSION GRANTED, IF
EEO OFFICIAL
OFFICIAL
(YYYYMMDD)
(YYYYMMDD)
APPLICABLE
(YYYYMMDD)
(YYYYMMDD)
16. DATE PRE-COMPLAINT INTAKE INTERVIEW CONDUCTED
17. PRE-COMPLAINT INTAKE INTERVIEW CONDUCTED:
(YYYYMMDD)
Telephonically
In-Person
Other (facsimile/e-mail)
SECTION II - ORGANIZATION WHERE ALLEGED DISCRIMINATION OCCURRED
(Complete address including office symbol)
SECTION III - RESPONDING MANAGEMENT OFFICIAL(s) INFORMATION
(Include name, complete work address and phone number if known.)
DA FORM 7510, JUL 2010
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1. DA DOCKET NUMBER
EEO COUNSELOR'S REPORT
For use of this form see AR 690-600, the proponent agency is OSA.
PRIVACY ACT STATEMENT (5 U.S.C. §552a)
Public Law 92-261
AUTHORITY:
Used for processing of complaints of discrimination because of race, color, national origin, religion, sex, age, physical
PRINCIPAL PURPOSE:
and/or mental disability, or reprisal by Department of the Army civilian employees, former employees, applicants for
employment and some contract employees.
Information will be used (a) as a data source for complaint information for production of summary descriptive statistics and
ROUTINE USES:
analytical studies of complaints processing and resolution efforts; (b) to respond to general requests for information
under the Freedom of Information Act; (c) to respond to requests from legitimate outside individuals or agencies
(White House, Congress, Equal Employment Opportunity Commission) regarding the status of a complaint or appeal; or
(d) to adjudicate complaint or appeal.
DISCLOSURE:
Voluntary, however, failure to complete all appropriate portions of this form may lead to delay in processing and/or rejection
of complaint on the basis of inadequate data on which to continue processing.
SECTION l - PRE-COMPLAINT INTAKE INTERVIEW
2. NAME OF AGGRIEVED
3. JOB TITLE
(Print-Last, First, Middle Initial)
4. PAY PLAN/SERIES/
5. DUTY ORGANIZATION
(Complete address including office symbol)
GRADE
6. WORK TELEPHONE
7. HOME TELEPHONE
8. HOME ADDRESS
10. 45
TH
CALENDAR DAY
11. REASON FOR DELAYED CONTACT BEYOND 45 DAYS, IF APPLICABLE
9. DATE OF ALLEGED
AFTER EVENT
DISCRIMINATORY ACTION
(YYYYMMDD)
(YYYYMMDD)
13. 30
TH
CALENDAR DAY
14. 90
TH
CALENDAR DAY AFTER
12. DATE OF INITIAL
15. DATE COUNSELING
AFTER INITIAL CONTACT WITH
INITIAL CONTACT WITH EEO OFFICIAL
CONTACT WITH EEO
EXTENSION GRANTED, IF
EEO OFFICIAL
OFFICIAL
(YYYYMMDD)
(YYYYMMDD)
APPLICABLE
(YYYYMMDD)
(YYYYMMDD)
16. DATE PRE-COMPLAINT INTAKE INTERVIEW CONDUCTED
17. PRE-COMPLAINT INTAKE INTERVIEW CONDUCTED:
(YYYYMMDD)
Telephonically
In-Person
Other (facsimile/e-mail)
SECTION II - ORGANIZATION WHERE ALLEGED DISCRIMINATION OCCURRED
(Complete address including office symbol)
SECTION III - RESPONDING MANAGEMENT OFFICIAL(s) INFORMATION
(Include name, complete work address and phone number if known.)
DA FORM 7510, JUL 2010
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SECTION IV - BASIS OF COMPLAINT
(Identify specific race, color, religion, national origin, disability, age, sex, or reprisal if alleged.)
RACE
COLOR
SEX
Male
Female
AGE
DATE OF BIRTH
NATIONAL ORIGIN
RELIGION
DISABILITY
Mental
Physical
REPRISAL
(Date(s) of prior EEO activity)
SECTION V - MATTER (s) GIVING RISE TO COMPLAINT
(Specify who, what, where, and when.) (Use additional sheet of paper if necessary.)
SECTION Vl - RELIEF SOUGHT
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SECTION Vll - RIGHTS AND RESPONSIBILITIES
THE AGGRIEVED WAS PROVIDED WITH THE AGGRIEVED PERSON'S RIGHTS AND RESPONSIBILITIES NOTICE AND WAS SPECIFICALLY
ADVISED OF THE FOLLOWING:
The basis (es) for filing pre-complaint, formal complaint, and/or class complaint, and of right to file a formal complaint of discrimination.
The pre-complaint, formal and/or class complaint process.
The 45-day calendar requirement from effective date of personnel action or of the date of the matter alleged to be discriminatory.
The role of the EEO counselor, including that the counselor is not an advocate for either the aggrieved person or the agency and acts
strictly as a neutral.
The activity's Alternate Dispute Resolution
Program and right to elect either ADR
or traditional EEO counseling.
(ADR)
(if offered)
The right to remain anonymous during the pre-complaint process.
The right to representation throughout the complaint process.
Responsibility of the aggrieved to notify the EEO office in writing of any change in address and/or phone number.
Responsibility of the aggrieved to notify the EEO office in writing of non-attorney or attorney representation, including address and phone
number.
The possible election requirement between a negotiated grievance procedure, MSPB procedure and the EEO complaint process.
The election options in age and wage-based discrimination complaints.
SECTION Vlll - ELECTION OF REPRESENTATION
ATTORNEY
NON-ATTORNEY
NON-REPRESENTATIVE
NAME OF REPRESENTATIVE
ADDRESS
TELEPHONE NUMBER
FAX
E-MAIL
SECTION IX - ALTERNATE DISPUTE RESOLUTION (ADR)
Matter determined not appropriate for ADR
(Aggrieved must sign and date)
Matter determined appropriate for ADR
(EEO Officer must initial and date)
Wishes to participate in ADR, if offered
(EEO Officer must initial and date)
Date of written offer of ADR
Date of Agreement to Participate in ADR
Name of assigned ADR facilitator/mediator
Date ADR facilitator/mediator assigned
Result of ADR:
ADR was successful. Negotiated settlement agreement, signed on
is attached.
(YYYYMMDD),
ADR was not successful. The aggrieved was issued a Notice of Right to File a Formal Complaint of Discrimination on
and notified of requirement to file a formal complaint within 15 calendar days after receipt of
(YYYYMMDD)
Notice of Right to File. The aggrieved was provided a DA Form 2590, Formal Complaint of Discrimination.
SECTION X - TRADITIONAL EEO COUNSELING
(EEO official to complete only those which apply.)
Election of traditional counseling.
Name of assigned EEO counselor
Date EEO counselor assigned
Election to remain anonymous.
Election to waive right to remain anonymous.
Declined to pursue matter under Title VII.
DA FORM 7510, JUL 2010
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SECTION Xl - WITNESS INQUIRY
a. Witness Information
(List all witness data here. Number sequentially and include name, title, organization, phone number, and relevant basis(es) information.)
b. Witness Statements
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SECTION Xl - WITNESS INQUIRY
(Cont'd)
Witness Statements
(Cont'd)
c. Documents Reviewed (List)
d. Reviewed Documents Revealed
SECTION Xll - OUTCOME OF PRE-COMPLAINT INQUIRY
Resolution was not accomplished, therefore, I conducted the final interview with aggrieved on
(YYYYMMDD) at which
time I informed the aggrieved of the full scope of my inqu
articulated by management for action(s) taken.
iry and the reason(s)
I provided the aggrieved with a Notice of Right to File a Formal Complaint of Discrimination and a DA Form 2590, Formal Complaint of
Discrimination. The aggrieved is aware of the requirement to file a formal complaint within 15 calendar days of the final interview if not
satisfied with the results of my inquiry.
Resolution was accomplished. Negotiated settlement agreement, signed on
(YYYYMMDD), is attached.
PRINTED NAME OF EEO COUNSELOR
SIGNATURE OF EEO COUNSELOR
Attachments:
DATE SUBMITTED TO EEO OFFICER
1. Extension of counseling
(YYYYMMDD)
(if applicable)
2. Copies of reviewed documents
DA FORM 7510, JUL 2010
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Download DA Form 7510 EEO Counselor's Report

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How to Fill Out DA Form 7510?

An overview of the form and filing guidelines can be found in the Army Regulation 690-600, Equal Employment Opportunity Discrimination Complaints, released in February 2004. DA Form 7510 instructions are as follows:

  1. Any job applicant, employee, contract employee, or former employee who believes to have been discriminated against because of their religion, race, sex, age, national origin, mental or physical disability and wants to report the act can initiate an EEO complaint process.
  2. The first part of the process is referred to as the "pre-complaint". At this stage, the individual visits an EEO official and states the desire to initiate the complaint process. This contact - or information inquiry - is documented using the DA Form 7509, Information Inquiry Summary. This stage lasts until the issuance of the Notice of Right to File a Formal Complaint of Discrimination to the estate administrator or executor.
  3. The individual that initiated the complaint is referred to as the aggrieved. The EEO counselor or official interview the aggrieved and record their complaint on the DA 7510. The official must then determine if the matter presented by the aggrieved can be processed under 29 CFR, Part 1614.
  4. After that, the EEO official will clarify and document the facts related to the specific incident, as well as other important information using the DA Form 7510 and conduct all further investigations according to the data collected.
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