Waiver IHS Provisional authorization memo.pdf
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- Solicitation number
- 75H70625Q00027
About this file
This is a Provisional Authorization form from the Indian Health Service Office of Human Resources for positions covered by Public Law 101-630 (Indian Child Protection and Family Violence Prevention Act) and 101-647 (Crime Control Act).
The form outlines requirements for new hires, contractors, volunteers, or affiliates who will have regular contact with or control over Indian children. These individuals must undergo a background investigation and maintain provisional status until favorably adjudicated. During provisional status, they must be supervised and within sight of staff who have approved background investigations with child care coverage. The form requires signatures from the department supervisor/designee, personnel security representative, and employee/contractor/affiliate acknowledging these requirements. The facility must maintain a list of approved staff members who can supervise provisional employees. Non-compliance can result in disciplinary action up to termination. This form is dated November 2018 and appears to be Appendix E of a larger document.
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To:
Subject:
New Hire and Supervisor of position covered by Public Law 101-630 Provisional Authorization- pending favorably adjudicated background investigation
This serves as not ice to the supervisor and new hire/contractor/volunteer/affiliate that they will be performing work and/or occupying a position that is covered by Public Laws (P.L.) 101-630, Indian Child Protection and Family Violence Prevention Act and 101-647, Crime Control Act. An individual employed/working or being considered for employment (Federal, contractor, volunteer, or affiliate) at the Indian Health Service with duties and responsibilities involving regular contact with or control over Indian children must undergo a background investigation. Prior to the receipt of a favorably adjudicated background investigation, the individual will have provisional status. At all times whenever Indian children are in the care, custody, and/or control of an individual in a provisional status, the individual is required to be under the supervision and in sight of a staff person who has a favorably adjudicated background investigation that includes child care coverage.
The following individual has been granted provisional authorization for the identified position, which has been designated as a position covered by P.L. 101-630:
Name: _________________________________ Position title: ____________________________ The following conditions must be met for the individual:
Pre-employment suitability has been favorably adjudicated prior to entrance on duty.
Continued processing of background investigation – Tier 1 with child care (minimum).
Provide requested documentation/information as requested from the Personnel Security/HR Office.
Supervisor must ensure that new hires/contractors/affiliates who are in a provisional status and have Indian children in their care, custody, and/or control, are within the sight and supervision of a staff person who has a favorably adjudicated background investigation that includes child care coverage.
Supervisors are required to sign indicating your acceptance, responsibility, and compliance with the above criteria, and will ensure that the above named individual is assigned to appropriate personnel whenever Indian children are in their care, custody, and/or control. Failure to comply with the above criteria can result in disciplinary action, up to and including removal.
Department Supervisor/Designee Date
The facility/service unit is required to work with the Area Personnel Security/HR Office designee to maintain a list of staff members who have a favorably adjudicated background investigation with child care coverage on file for supervisors to identify and assign personnel to provide coverage to individuals in a provisional status.
I have verified that I have worked with the facility/service unit to ensure that a list of favorably adjudicated staff members is available for the supervisor’s use.
Personnel Security Representative/HR Designee Date
This provisional authorization is in effect until the favorably adjudicated certification of investigation is in place. I am aware that failure to comply with the above criteria could result in disciplinary action, up to and including removal/termination.
Employee/Contractor/Affiliate Date
11 / 2018
Indian Health Service Office of Human Resources
Appendix E
| Position title: |
| Department SupervisorDesignee: |
| Date: |
| Personnel Security RepresentativeHR Designee: |
| Date_2: |
| EmployeeContractorAffiliate: |
| Date_3: |
| Name: |
File details come from the government source that posted it. Updated .