Who files VA Form 4939?
VA Form 4939 can be used by VA employees, former employees and applicants for employment who file a formal equal employment opportunity (EEO) complaint of discrimination.
What is the purpose of VA Form 4939?
VA Form 4939 is a complaint of employment discrimination that is used pursuant to the Equal Employment Opportunity Commission (EEOC) Title 29 Code of Federal Regulations (CFR) §1614.
When is VA Form 4939 due?
You must file your complaint within 15 days after the date you received the “Notice of Right to File a Discrimination Complaint” NR FTF) from your EEO Counselor. If you do not comply with this requirement, you must provide an explanation of why you waited more than 15 days to file. Under certain circumstances, these time limits may be extended.
How do I fill out VA Form 4939?
If you need any assistance in filling out this form, you can obtain it from your EEO Counselor.
In item 8, you have to specify the basis of your complaint: race, national origin, gender (sex), religion, age, mental or physical disability (specific information about your disability), genetic information, and/or reprisal for prior EEO activity. If you list “Reprise”,” please state the nature of the prior EEO activity in which you were engaged, i.e. did you file before an EEO complaint? You should be precise as to the dates of all events or actions you are protesting.
The claims listed in item 9, must be limited to those claims discussed with an EEO Counselor (discussed within 45 days after the occurrence of the event, or within 45 calendar days of the effective date, if a personnel action) or like or related claims. If you discussed with an EEO Counselor any of the claims listed in item 9, but not within 45 calendar days of their occurrence or of their effective date, you must explain the reason why you waited more than 45 days. If you did not discuss any of the claims listed in item 9 with an EEO Counselor, please immediately ?contact the Office of Resolution Management (ORM), Regional EEO Officer. The requirement to contact an EEO Counselor about every claim listed in item 9 will not be waived under any circumstances. Failure to do so will delay the processing of your complaint. You must keep the ORM informed of your current address. If you move, immediately notify the ORM Field Office where you filed this complaint of your new address.
You may receive certified and express mail in connection with your complaint. It is your responsibility to claim all certified and express mail. If you fail to notify ORM of a change in address or to claim certified and express mail, your complaint may be dismissed.
Where do I send VA Form 4939?
You should file your complaint with the ORM Field Office identified in the NRT For the Deputy Assistant Secretary for ORM. You may submit a copy either by mail, in person, electronically (via e-mail), or by facsimile.
