(Signature Authority is based on Component’s Guidance and Instruction)

Date

1. I, _____________(Title, Home Agency’s Name and Specific Office), request that (Assignee’s Legal Name), be assigned to the Office of the Director of National Intelligence (ODNI), (Specify Office) for (# of months), with a requested start date ofstart date of XXX and end date of XXX. I understand that this will be a NON-REIMBURSABLE assignment and that, as an Assignee, (Assignee’s full Name) will continue to support (Home Agency’sName)missions and functions.

2. (Assignee’s Legal Name) primary duty while assigned to ODNI (Specify Office) will be (provide duty description to be performed).

3. It is understood that (Assignee’s Legal Name) will do the work of and remain under the control and authorityof (Home Agency’s Name). (Home Agency’s Name)will pay the assignee’s salary, benefits, any bonus or awards, and be accountable for Assignee’s Legal NameTime and Attendance. Assignee’s Legal Nameis expected to perform only those duties that directly benefit Home Agency’s Name’s missions and objectives. As such, he/she is not an ODNI detailee and at no such time will perform duties that solely support the ODNI’s missions and functions.

4. Please contact XXXX at 123-745-7859 (open) or 123-1235 (secure) or email: john. doe@xxxi. ic. gov for further information pertaining to the above stated employee.

___SIGNATURE_________________
Printed Name

Title

Agency/ Component Information

(Signature Authority is based on Component’s Guidance and Instruction)

Agency’s D/DD Human Resources Concurrence / Non-Concurrence

___SIGNATURE_________________
Printed Name Date

Title

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