1-101

U.S. Department of Labor

Training Authorization and Evaluation

Instructions: Part A is to be completed by employee/authorizing officials for all courses. Part B is to be completed only if there is a direct cost associated with the training. Part C is to be completed by the employee/supervisor upon course completion. (Detailed instructions on reverse side.)

A. Required Information 1. Name of Employee (Last, First, Middle)

2. Social Security Number

3. Agency, Contact Name and Phone

4. Full Course Title

5. Personnel Office (CCPO) Code:

6. Date Course (Month/Day/Year) V

Begins:

7. DOL Training Activity/Source Code

Course Cat.

Total Hours:

Ends: Source Code

8. Comments/Special Instructions:

9. Employee Responsibility and Agreement: I agree to reimburse any training expenses if I do not satisfactorily complete this course. I agree to continued service requirements, if applicable (Non-Govt training over 80 hours). I certify that I have read and understand the statements on the reverse

Date

Employee signature 10. Authorizing Official Signature(s)/Resource Manager(s)

B. Cost Only 11. Training Vendor Name, Address, Telephone & Fax Number

12. Direct Cost (Dollars Only)

13. Vendor (EIN)

Tuition

city

state

phone

zip

fax

14. Geographic Location of Training (City/State):

Books Other Total

city

15. Training Vendor Submits Invoice to:

state 16. Agency Location Code (ALC)

17. Accounting Classification Code (22-Digits)

18. Obligating Document Number (completed by Agency)

C. Course Completion Certification I certify that I did

did not

complete this course.

19. Employee Signature and Date

Exception to SF-1 82 Approved by GSA/ITC

Supervisor Signature and Date (Agency discretion)

DL Form 1-101 (Jan/99) Previous editions obsolete

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TRAINING AUTHORIZATION AND EVALUATION FORM THE DL1-101 IS TO BE USED TO REQUEST, APPROVE, AND RECORD ALL TRAINING. THE DL1-101 MAY BE USED AS A PAYMENT DOCUMENT FOR A SCHEDULED INDIVIDUAL COURSE. A MANAGER OR SUPERVISOR WHO WANTS TO PURCHASE AN OFFTHE-SHELF COURSE OR HAVE A CONSULTANT DESIGN A COURSE FOR A GROUP OF EMPLOYEES MUST FOLLOW STANDARD PROCUREMENT PROCEDURES FOR OBTAINING AND PAYING FOR SUCH TRAINING. THIS REQUIRES THAT A DL1-1 (DEPARTMENT OF LABOR REQUISITION FOR EQUIPMENT, SUPPLIES OR SERVICES) BE USED TO REQUEST THE APPROPRIATE PROCUREMENT ACTION. MANAGERS AND SUPERVISORS SHOULD CONSULT THEIR SERVICING PROCUREMENT OR FINANCIAL SERVICES OFFICE FOR FURTHER GUIDANCE. COMPLETION OF A DL1-101 IS ALSO REQUIRED FOR ALL TRAINING PROCURED THROUGH A DL1-1. COMPLETION INSTRUCTIONS A. REQUIRED INFORMATION

1. Through 4. Self explanatory.

5. PERSONNEL OFFICE CODE - Select appropriate Servicing Personnel Office CODE: VA=BOS VB=NY

VC=PHIL VD=ATL

VE=CHI VF=DAL

VG=KC VH=DEN

VI=SF VJ=SEA

VK=CPSC VL=ESA

VM=ETA VN=BLS

VP=MSHA VR=OSHA

VS=SOL VZ=OIG

6. DATE COURSE BEGINS AND ENDS AND TOTAL HOURS: Assure that all dates are filled in using the sequence - Month/Day/Year (e.g., 01/09/03 for January 9, 2003). 7. DOL TRAINING ACTIVITY/SOURCE CODE: Select a code which best describes the Course Category and Source of Training. ______________1st Block=Course Category_______________ E=Executive M=Managerial/Supervisory P=Professional/Technical

A=Administrative/Office Skills O=Other

____________2nd Block =Training Source Category____________ I=Internal/OHR/CLCMC J=Other Internal DOL Training K=Inter-Agency (e.g., OPM)

L=College, Professional Ass. M=Private Industry or Other

8. COMMENTS/SPECIAL INSTRUCTIONS: This block should include such things as special accommodations; designate training procured through DL 1-1 and any agency-specific requirements. 9. EMPLOYEE RESPONSIBILITY AND AGREEMENT: I agree to satisfactorily complete the training for which I am being nominated. (Satisfactory completion means: ungraded courses--satisfactory completion of necessary course work and attendance requirements; graded courses-the final grade received must be one which is acceptable for academic credit by the facility.) I understand that if I fail to satisfactorily complete the training, withdraw for unacceptable reasons or change from credit to audit without prior approval, I will be responsible for reimbursing the Department for any funds (excluding salary) expended for the training. Agreement to Continue in Service: In consideration of the Department’s paying my training expenses, I hereby agree to complete the training described herein. Upon completing the training, I agree to continue serving in the Department for at least three times the number of hours spent in training, unless I am involuntarily separated from the Department. In addition, I agree to give the head of my Agency or office at least ten workdays’ notice in writing if I decide to enter the service of another agency of the Federal Government before completing this period of service. If I fail to give the required advance notice before entering the service of another Federal agency, or if I otherwise leave the service of the Department voluntarily before completing the agreed period of service, I agree to refund to the Department any sums that have been paid by the Department in connection with the training (other than salary), unless waived in whole or in part by the parent agency. 10. AUTHORIZING OFFICIAL SIGNATURE(S)/RESOURCE MANAGER(S): Signature authority is at agency discretion. More than one signature may be necessary to meet agency requirements, i.e., supervisory signature to approve training, authorizing official and/or human resource manager to certify availability of funds. Check with your Administrative Office for specific requirements for your agency. B. COST ONLY

11. Self explanatory

12. DIRECT COSTS: All Direct Cost must be reported. Do not include Travel, Per Diem or any cost related to Indirect Cost on this form. 13. VENDOR EIN: Completed by Agency Administrative Office or Training Office. For each Direct Cost, enter either the vendor’s Federal Employer Identification or Social Security number, as applicable. 14. LOCATION OF TRAINING: City or State where training actually takes place. 15. TRAINING VENDOR SUBMITS INVOICE TO: Completed by Agency Administrative Office or Training Office. 16. AGENCY LOCATION CODE (ALC): Central Personnel Services Center (CPSC)& SOL = 16012014 BLS = 16012011 ESA = 16012013 ETA = 16012016

OSHA = 16012012 MSHA = 16120001 BOS = 16012001

NY = 16012002 PHIL = 16012003 ATL = 16012004

CHI = 16012005 DAL = 16012006 KC = 16012007

DEN = 16012008 SF = 16012009 SA = 16012010

17. ACCOUNTING CLASSIFICATION CODE: Self explanatory. 18. OBLIGATING DOCUMENT NUMBER: Completed by Agency Administrative Office or Training Office. C. COURSE COMPLETION CERTIFICATION

19. Employee signature required, Supervisor signature is at Agency discretion.