Form DOJ-JMD-FS-2 "Investigation Report for Request to Compromise a Claim for a Debt Owed to Doj by an Employee"

What Is Form DOJ-JMD-FS-2?

This is a legal form that was released by the U.S. Department of Justice on June 16, 2003 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

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Download Form DOJ-JMD-FS-2 "Investigation Report for Request to Compromise a Claim for a Debt Owed to Doj by an Employee"

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INVESTIGATION REPORT
For Request to Compromise a Claim for a Debt Owed to DOJ by an Employee
(References: 31 CFR Parts 900 et al; 5 USC 5584; 31 USC 3711 )
(*Maintain Report for 6 years & 3 months)
Date Waiver Request Signed:___________
Date Request Received:_____________
Investigation Report Date*:_____________
Current Agency:______________________
Agency at time of error:_____________
Employee Name:_______________________________
SSN:________________
Overpayment Period:____________________________________________
Bill Number:________________________
Bill Date:___________
Biweekly Error Amount: $_____________
Total Debt Amount: $______________
Date Personnel Office Notified NFC to Suspend Collection:_____________
Is Overpayment Amount $100 to 100,000?______________
☐ Pay &/or Allowances
Check Appropriate Overpayment Type:
☐ Cash Award or Quality Step Increase
☐ Understated Deductions (withholdings/benefits)
☐ Negative Leave Balance generating bill
Nature of Overpayment:__________________________________________________________
Is this error the first occurrence of this type for this employee? ___. If no, when was previous
overpayment & why did it happen again? ____________________________________________
Date Error Discovered:______________
Date Error Corrected:_______________
Office or Person who Discovered Error:___________________________________________
Was the compromise of claim form (DOJ-127 Revised) signed by the employee☐ , the
beneficiary of a deceased debtor’s estate☐ , the employing office official☐ ?
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INVESTIGATION REPORT
For Request to Compromise a Claim for a Debt Owed to DOJ by an Employee
(References: 31 CFR Parts 900 et al; 5 USC 5584; 31 USC 3711 )
(*Maintain Report for 6 years & 3 months)
Date Waiver Request Signed:___________
Date Request Received:_____________
Investigation Report Date*:_____________
Current Agency:______________________
Agency at time of error:_____________
Employee Name:_______________________________
SSN:________________
Overpayment Period:____________________________________________
Bill Number:________________________
Bill Date:___________
Biweekly Error Amount: $_____________
Total Debt Amount: $______________
Date Personnel Office Notified NFC to Suspend Collection:_____________
Is Overpayment Amount $100 to 100,000?______________
☐ Pay &/or Allowances
Check Appropriate Overpayment Type:
☐ Cash Award or Quality Step Increase
☐ Understated Deductions (withholdings/benefits)
☐ Negative Leave Balance generating bill
Nature of Overpayment:__________________________________________________________
Is this error the first occurrence of this type for this employee? ___. If no, when was previous
overpayment & why did it happen again? ____________________________________________
Date Error Discovered:______________
Date Error Corrected:_______________
Office or Person who Discovered Error:___________________________________________
Was the compromise of claim form (DOJ-127 Revised) signed by the employee☐ , the
beneficiary of a deceased debtor’s estate☐ , the employing office official☐ ?
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Employee Name: ___________________________
Was employee told of overpayment? _______
If Yes, provide date(s) of verbal and/or written notification(s): ___________________________
Did employee know of overpayment without being told? _______
Did employee report it (if so, indicate to whom)? ______________________________________
If Yes, was it promptly reported to the Servicing Personnel Office by employee or employee’s
supervisor? _________
Indicate response to employee (e.g., Did supv or SPO agree that there was an error?):
______________________________________________________________________________
Personnel Office’s statement regarding whether there was any indication of deceit,
misrepresentation, fault, or lack of good faith on the employee’s or requester’s part:
______________________________________________________________________________
Personnel Office’s statement as to whether corrective action is being taken to prevent the
occurrence of similar erroneous payments:
______________________________________________________________________________
Is the employee separated or deceased? ______
If No, does the employee have a “Not to Exceed” (NTE) appointment date? ________
If Yes, provide the NTE date: _________
Enter the Following Employee Facts ->
Federal Service Computation Date:_______________________________
Last Promotion Effective:_______________________________________
Within Grade or Quality Step Increase Effective, if pertinent:____________________
Required waiting period for WGI:_____________________
Pay Plan, Grade, Step at time of error:______________________________________
Occupation/Job Title at time of error:_______________________________________
FEGLI or Health Benefits info, if pertinent:__________________________________
Did pay fluctuate considerably for several pay periods before the error?____________
Was there a substantial increase in pay when the error occurred?_________________
Check the items that were submitted with the waiver request form:
☐ Notifications of Personnel Action (SF-50)
☐ Certified Income & Expense Statement
☐ Earnings & Leave Statement
☐ Copy of bill (Employee Notice)
☐ Time & Attendance Report
☐ Schedule of Erroneous Payment
☐ Employee benefit election form
☐ Notice of pay entitlement or pay cap
☐ Job Vacancy Announcement
☐ Other, as specified:
☐ Allowance Agreement
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Employee Name: ______________________________
Criteria for Compromise when Overpayment is $100,000 or less: In addition to ensuring that
there is no indication of fraud, misrepresentation, fault or lack of good faith, at least one of the
three criteria set forth in DOJ Order 2120.4E, Guideline #2 (shown below), must be satisfied to
approve a request for compromise. Can “yes” be answered to both “no fraud/fault, etc.,” and to
any one of these questions? If yes, indicate item number(s):____________________________
1.
Is debtor unable or unwilling to pay debt in full and would DOJ be unable to collect
within a reasonable time by enforced collection proceedings?
2.
Is there substantial doubt of DOJ’s ability to prove its case in a court of law? Would it be
difficult to prove that employee was overpaid or that the amount of the overpayment was
accurate?
3.
Does the anticipated cost of collection (aside from salary offset) equal or exceed the
amount owed and employee’s agency does not take the position of demonstrating to
other debtors that resistance to payment is not likely to succeed?
Do any of the following approving standards apply? If yes, indicate item number(s):__________
1.
Collection would cause serious financial hardship to the employee from whom collection
is sought (employee submitted a certified income and expense statement).
2.
Due to the overpayment, the employee has relinquished a valuable right or changed
positions for the worse, regardless of the employee’s financial circumstances.
3.
Given the substantial
amount of the debt (up to $2,999.99), repayment may result in tax
consequences for the employee (i.e., debt of less than $3,000 occurred in one tax year,
and full repayment made [to be made] in a subsequent tax year). A partial compromise
may be considered.
4.
The cost of collecting (aside from salary offset) equals or exceeds the amount of the
claim.
5.
The type of pay error was not apparent to most employees whose job does not require
knowledge of pay entitlements; employee received SF-50(s) untimely (i.e., received
several pay periods after the error occurred and error not apparent on Earnings Statement
or employee did not receive a notice of entitlement [what to expect] before or at the onset
of the error]); or there was a fluctuation of pay for several pay periods before the error
occurred and error not apparent on Earnings Statement.
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Employee Name: ________________________________
Do any of the following denial standards apply? If yes, indicate item number(s): ____________
1.
There was indication of fraud, misrepresentation, fault, or lack of good faith (derived from
an act or a failure to act).
2.
Employee received or had access via the Internet comprehensible Earnings & Leave
Statements and/or T&A Reports, yet was paid for more hours in a pay status than his/her
entitlement.
3.
Employee’s job occupation was in the area of personnel or payroll, which precluded
him/her from claiming no knowledge of the pay error.
4.
Employee was not new to the Federal government (as reflected in his/her Federal Service
Comp Date), and the error was not of a complex nature.
5.
Employee received a letter, memo, or notice outlining his/her pay setting, pay cap, or pay
entitlements.
6.
Employee signed an agreement for an allowance, but did not fulfill the terms of such
agreement.
7.
Employee signed an election form for a benefit that was not sufficiently deducted from
his/her pay.
8.
Employee’s leave adjustment(s) did not result in a negative leave balance at any time.
Therefore, there is no claim to waive.
Personnel Officer’s Recommendation & Reason(s) (include amount(s) recommended to be approved
and/or denied):
Amount Recommended to be Approved:
$_________________
Amount Recommended to be Denied:
$_________________
_____________________________________________________________________________________
_______________________________
____________________
(Signature of Personnel Officer)
(Date)
DECISION:
Amount Approved:
$__________________
Amount Denied:
$__________________
Decision Official’s Reason for Disagreement or Concurrence if Different Reason than Agency’s:
______________________________________________________________________________
________________________________
_____________________
Decision Official’s Signature
(Date)
Decision Official’s Title: __________________________________________
U.S. DOJ - Inv Rep Form
Form DOJ-JMD-FS-2 (06-16-03)
Authorized for Local Reproduction
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