GSA1996

Telework Agreement

Agency
GSA
Revision
Rev. 2/2025
Fillable fields
48
Pages
3
Official source
GSA form page
Checked
October 20, 2026
Fill GSA1996 online
Page 1 of form GSA1996

GSA Form 1996: Telework Agreement

GSA Form 1996, Telework Agreement, is a GSA form for GSA employees entering into telework agreements. The footer reads GENERAL SERVICES ADMINISTRATION and GSA 1996 (REV. 2/2025), and GSA's page lists the authority or regulation as ADM 6040.1A. GSA hosts it in its forms library.

The form says telework agreements will be completed electronically using GSA's approved telework agreement system, which merges Telework and Full-Time Telework Agreements into a single agreement, and that this PDF shows the telework data elements included in the electronic form. It has four sections: general information, certification of completing training, employee information with the employee certification, and supervisor information with the supervisor certification, followed by a Privacy Act Statement.

The Privacy Act Statement says furnishing the information is voluntary. You can fill out this copy free in your browser on this page and download the result without an account.

Top of page 1 of GSA Form 1996: Telework Agreement, as printed by GSA

What's on GSA Form 1996

Section 1: general information

Items 1 to 11: employee name, date submitted, service or staff office, office symbol, official work site or duty station, employee and first line supervisor phone and email, and management's eligibility answer.

Section 2: training

Item 12, a yes or no statement that the employee understands they are required to complete mandatory telework training.

Section 3, items 13 to 16: choice and schedule

Whether the employee would like to telework, a statement for declining, an approved exemption (Reasonable Accommodation, Military Spouse or Other Exemption) and the schedule: Situational, Routine or Full-Time Telework.

Section 3, items 17 and 18: telework ready

Statements on having the IT tools, equipment and training of a telework ready employee and on responsibilities under GSA's Dismissal and Closure Procedures, then the employee certification.

Section 4: supervisor information

Items 19 to 23: temporary ineligibility, its reason and a plan to resume or establish eligibility, and position or permanent ineligibility under the Telework Enhancement Act of 2010, then the supervisor certification.

Privacy Act Statement

Page 3 explains the authority, purpose and routine disclosures for the information and says furnishing it is voluntary.

How to complete GSA Form 1996

  1. 1

    Complete Section 1

    Enter the name, date submitted, office, work site, phone, email and first line supervisor in items 1 to 10. Item 11 is completed by management.

  2. 2

    Answer the training item

    Check yes or no in item 12 about mandatory telework training.

  3. 3

    Give the telework choice

    Answer item 13. The form says if Yes, skip item 14 and go to item 15; if No, go to item 14, then skip items 15 and 16 and go to item 17.

  4. 4

    Pick an exemption and schedule

    Item 15 says an approved exemption is required for Routine Telework and Full-time Telework. Item 16 says situational telework is the only type available for all employees unless they have an approved exemption.

  5. 5

    Sign the employee certification

    Answer items 17 and 18, then sign and date the employee certification, which lists the employee's responsibilities under the agreement and agency policy.

  6. 6

    Supervisor review

    The form says the agreement auto flows to the supervisor for review, approval and initial of concurrence of item 15. The supervisor completes Section 4 and signs.

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Submission and privacy

How it is completed

The form says telework agreements will be completed electronically using GSA's approved telework agreement system. It prints no mailing address.

Routing

Upon completion of Sections 1, 2 and 3, the form says the agreement auto flows to the supervisor for review and approval.

Authority

GSA's page lists ADM 6040.1A. The Privacy Act Statement cites GSA Directive ADM 6040.1A and Public Law 106-346, § 359 of October 23, 2000.

Privacy

The form says the information is subject to the Privacy Act of 1974 as amended, 5 U.S.C. Section 552a, lists the parties it may be disclosed to, and says furnishing it is voluntary.

Related forms

Who fills out GSA Form 1996?

  • GSA employees

    The Privacy Act Statement says the form collects data from GSA employees entering into telework agreements. Section 3 is to be completed by the employee, who signs the employee certification.

  • Management

    Item 11 in Section 1 is to be completed by management: whether the position is telework eligible and, if not, the reason.

  • The employee's supervisor

    Section 4 is to be completed by the employee's supervisor, who signs the supervisor certification. The form says the agreement auto flows to the supervisor after Sections 1, 2 and 3.

  • Telework coordinators

    The employee certification says the agreement may be used or reviewed by management and local telework coordinators to implement agency policy and assess GSA's Telework Program.

The section headings say who completes each part.

Official sources and the blank

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Questions about Form GSA1996

Who issues GSA Form 1996?

The footer reads GENERAL SERVICES ADMINISTRATION and GSA 1996 (REV. 2/2025). GSA hosts it in its forms library, and its page lists the authority or regulation as ADM 6040.1A.

Is GSA Form 1996 completed on paper?

The form says telework agreements will be completed electronically using GSA's approved telework agreement system, and that this representation shows the telework data elements included in the electronic form.

What telework schedules does the form list?

Situational Telework, approved case by case; Routine Telework, on a previously approved regular schedule with a maximum number of days per pay period; and Full-Time Telework. The form says situational telework is the only type available for all employees unless they have an approved exemption.

What exemptions does item 15 list?

Reasonable Accommodation, Military Spouse, and Other Exemption (Approved by the GSA Administrator or their designee).

What does item 14 say about declining telework?

It says declining telework in item 13 does NOT preclude the employee from being telework-ready and required to telework, or take leave or other time off, or reschedule an alternate work schedule, in certain emergency situations.

How does the form define permanent ineligibility?

As positions or employees officially disciplined with a warning, reprimand, suspension or removal for being AWOL for more than five (5) days in any calendar year, or for violations of subpart G of the Standards of Ethical Conduct for Employees of the Executive Branch described under item 23.

Is the information on GSA Form 1996 voluntary?

The Privacy Act Statement says furnishing the information on this form is voluntary.