OF69
Assignment Agreement
Optional Form 69 (OF 69), Assignment Agreement, is a U.S. Office of Personnel Management (OPM) form, printed as OF 69 (REV. 2-89) with FPM Chapter 334 and Title IV of the Intergovernmental Personnel Act of 1970 (5 U.S.C. 3371-3376). GSA hosts a copy in its forms library.
The form says the agreement constitutes the written record of the obligations and responsibilities of the parties to a temporary assignment arranged under the Intergovernmental Personnel Act of 1970. It says the term State or local government also refers to an institution of higher education, an Indian tribal government and any other eligible organization.
The four pages hold 15 parts and 44 numbered items: the employee, the parties, the positions, the type, reason and duties of the assignment, pay, benefits, fiscal obligations, travel, the rules that apply, and certifications by the employee and the authorizing officers of both governments. You can fill it out free in your browser on this page and download the result without an account.
New agreement, modification or extension; the employee's name, Social Security number, home address and any earlier mobility assignments; the Federal agency, the State or local government and any faculty fellows program.
The position currently held, the type of current appointment (Federal grade level, or State or local annual salary and original date employed), and the position to which the assignment will be made.
Detail, leave or appointment; full time, part time or intermittent; the period of assignment; the reasons and how the work will benefit the participating governments; and the major duties.
Rate of basic pay, special pay conditions and leave provisions; Federal and State or local fiscal obligations; and coverage for Federal life insurance, retirement and health benefits, State or local benefits and other benefits.
Conflict-of-interest and conduct boxes, who pays travel and transportation expenses, and five statements, A to E, the employee checks in item 34.
The assigned employee's certification and signature, then the certifications and signatures of the authorizing officers of the State or local government agency and the Federal agency.
The 15 parts fall into these groups.
In item 1, check New Agreement, Modification or Extension.
Complete Parts 2 to 4: the employee, the Federal and State or local parties, the current position and appointment, and the assignment position.
Complete Parts 5 to 12: type and period, reasons, duties, pay, leave, fiscal obligations, benefits and travel. Item 30 says to indicate coverage N/A if not applicable.
The employee checks the boxes that apply in item 34. Statement E is marked For Federal Employees only.
The assigned employee signs item 37, and the authorizing officers sign items 39 and 40 with dates and typed names and titles.
The form says two copies go to OPM within 30 days of the effective date of the assignment, and copies should be retained by each signatory.
These steps follow the form's parts and its instructions box.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The 1989 edition prints: U.S. Office of Personnel Management, Personnel Mobility Program, Staffing Operations Division/CEG, 1900 E street, NW, Washington, D.C. 20415.
The form says two copies must be sent within 30 days of the effective date of the assignment.
The form says copies of the completed and signed agreement should be retained by each signatory.
The form points procedural questions to mobility program coordinators in each Federal agency or to the staff of OPM's Personnel Mobility Program.
The Privacy Act Statement cites Sections 3373 and 3374 of Title 5, U.S. Code, and Executive Order 9397 for the Social Security number. It says furnishing the SSN or other data is voluntary.
The instructions and the certification parts name the people who sign, keep and receive the agreement.
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The form is printed as a U.S. Office of Personnel Management form, OF 69 (REV. 2-89), FPM Chapter 334. GSA hosts a copy in its forms library.
The form says it constitutes the written record of the obligations and responsibilities of the parties to a temporary assignment arranged under the Intergovernmental Personnel Act of 1970.
The form says the term also refers to an institution of higher education, an Indian tribal government and any other eligible organization.
The form says two copies go within 30 days of the effective date to OPM's Personnel Mobility Program, Staffing Operations Division/CEG, 1900 E street, NW, Washington, D.C. 20415, and each signatory keeps copies.
Statement E, for Federal employees only, is an agreement to serve in the Civil Service for a period equal to the assignment. It says failing to serve that time makes the employee liable to the United States for all expenses (except salary) of the assignment.
Statement C says travel and transportation expenses covered from Federal agency appropriations may be recoverable as a debt due the United States if the employee does not serve until the end of the assignment or one year, whichever is shorter, unless terminated earlier by either employer.
The Privacy Act Statement says furnishing the SSN or any other data requested is voluntary, and that not providing information may result in being ineligible for participation in the Intergovernmental Assignment Program.
