Item 1: employee, service period and duty station
The employee's name, the minimum number of months of service, the starting and ending pay period numbers, the date of appointment or assignment, the end date and the duty station.
GSA3689
Employee's Service Agreement for Receipt of a Relocation Incentive
- Agency
- GSA
- Revision
- Rev. 1/2021
- Fillable fields
- 40
- Pages
- 2
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 3689: Employee's Service Agreement for Receipt of a Relocation Incentive
GSA Form 3689, Employee's Service Agreement for Receipt of a Relocation Incentive, is a U.S. General Services Administration form. Its footer reads GENERAL SERVICES ADMINISTRATION, GSA 3689 (REV. 1/2021), and GSA's page lists the authority as HRM 9575.1 CHGE 1. GSA hosts it in its forms library.
The agreement is written in the first person for the employee. In item 1 the employee states that, in order to be paid a Relocation Incentive under 5 U.S.C. § 5753 and 5 C.F.R. Part 575, Subpart B, they agree to complete a minimum period of months of service with the U.S. General Services Administration at a named duty station. It is an internal GSA personnel agreement, not a form the public files.
The 11 numbered items cover the service period, the incentive amount, how it is paid, when the agreement ends, keeping a residence in the new location and when money is repaid. Its only signature line is the employee's. You can fill it out free in your browser on this page and download the result without an account.
What's on GSA Form 3689
Items 2 and 3: amount and payment method
The incentive amount in dollars and as a percentage of basic pay, then an initial lump sum, installments, a final lump sum or a combination, with a table for installment dates and amounts.
Items 4 and 5: when the agreement ends
Termination for the agency's management needs, and termination on demotion or separation for cause, a rating of record below Meets Performance Expectations or failure to fulfill the terms.
Items 6 to 9: payments after termination
What the employee receives, keeps or repays when the agreement ends under 5 C.F.R. § 575.211(a) or (b), pro rata repayment for an incomplete period, and how amounts due are recovered.
Item 10: residence in the new location
The form says the agreement will be terminated if the employee fails to maintain a residence in the new geographic location for the duration of the agreement.
Item 11 and signature
The rule for involuntary separation for reasons other than misconduct or delinquency and for a further relocation, then the employee's signature and date.
How to complete GSA Form 3689
- 1
Fill in item 1
Enter the employee's name, the minimum months of service, the starting pay period number and date of appointment or assignment, the ending pay period number and date, and the duty station.
- 2
Enter the amount in item 2
Write the incentive payment amount in dollars and the percentage of the basic rate of pay it represents.
- 3
Pick a payment method in item 3
Choose a, b, c or d. For installments, the form says the timing of the installment payments must be specified. For options b or d, use the table and attach additional pages as necessary.
- 4
Read items 4 to 11
These items set out when the agreement may be terminated, the residence condition, and what is paid, kept or repaid in each case.
- 5
Sign and date
The employee signs and dates the agreement at the bottom of the back page.
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Authority and terms printed on the form
Where it goes
The PDF gives no filing address or routing, and prints no OMB number or Privacy Act notice.
Authority
Item 1 cites 5 U.S.C. § 5753 and 5 C.F.R. Part 575, Subpart B. Items 6 and 7 cite 5 C.F.R. § 575.211(a) and (b) and section 6 of HRM 9575.1 CHGE 1, which GSA's page also lists.
Repayment
Item 8 says that if the period of employment is not completed, for reasons unacceptable to the agency, the bonus is repaid on a pro rata basis, with credit for each full month of employment completed.
Recovery of amounts due
Item 9 says amounts due to the agency may be withheld from any monies owed by the Government, or recovered by other methods approved by law.
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Who uses GSA Form 3689?
The form names these parties. It prints no filing address or routing.
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Questions about Form GSA3689
Who issues GSA Form 3689?
The footer reads GENERAL SERVICES ADMINISTRATION, GSA 3689 (REV. 1/2021). GSA hosts it in its forms library, and GSA's page lists the authority as HRM 9575.1 CHGE 1.
Who signs GSA Form 3689?
The form has one signature line, for the employee, with a date. It is written in the first person for the employee receiving the relocation incentive.
What does the form say about where the employee lives?
Item 10 says the service agreement will be terminated if the employee fails to maintain a residence in the new geographic location for the duration of the agreement.
What payment options does the form list?
An initial lump sum at the start of the service period, installments throughout it, a final lump sum on completion of the full period, or a combination of these, explained on the form.
How does the form say repayment is calculated?
Item 8 says the bonus is repaid on a pro rata basis, with credit given for each full month of employment completed.
What does the form say about involuntary separation?
Item 11 says that after involuntary separation for reasons other than misconduct or delinquency, the employee will not be required to repay monies for any unfulfilled period in item 1. It says this also applies when the Administrator determines in writing that another relocation to a different commuting area is necessary.