Common Contracts

Intergovernmental Personnel Act (IPA) Assignment Agreement

July 27th, 2023

• Filed
  July 27th, 2023

INSTRUCTIONS: This agreement constitutes the written record of the obligations and responsibilities of the parties to a temporary assignment arranged under the provisions of Title IV of the Intergovernmental Personnel Act (IPA) of 1970 (5U.S.C. 3371-3376). Copies of the completed and signed agreement should be retained by each signatory. Procedural questions on completing the assignment agreement form or on other aspects relating to the IPA program should be addressed to the Bureau’s servicing HR Specialist. The Privacy Act Statement is found at the bottom of this form. PART 1 – NATURE OF ASSIGNMENT AGREEMENT 1. Check all that apply: New Agreement Modification of Existing Agreement Extension of Existing Agreement PART 2 – INFORMATION ON PARTICIPATING EMPLOYEE 2. Name (Last, First, Middle.) 3. Social Security Number (Last 4 digits.) 4. Home Address (Street, City, State, ZIP Code.) 5. Has assignee ever served on a previous IPA assignment? Yes (Complete 6) No (Omit 6) 6. Dates of previous