PS Form 650 - Request for ELM 650 Mediation 2026

The document is a request form for mediation under the Employee and Labor Relations Manual (ELM) 650, intended for employees of the USPS who have received disciplinary actions. It includes sections for appellant information, issuing management details, type of discipline, representative information, and a request for mediation. The appellant acknowledges their rights to appeal and outlines the process for submitting the mediation request within ten days of receiving disciplinary action. Additionally, it contains privacy statements regarding the handling of personal information.

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Click ‘Get Form’ to open the PS Form 650 in our editor.
Begin by filling out the Appellant/Requester Information section. Enter your name, employee identification number, and contact details including home and office telephone numbers.
Provide your position level, title, duty hours, and facility finance number. Ensure that your home mailing address is complete with city, state, and ZIP+4.
In the Issuing Management Official Information section, input the name and job title of the management official along with their telephone number.
Select the type of discipline issued by checking one of the options provided in Section III.
Complete the Representative Information section with your representative's details including their name, contact information, work location, and organization.
In Section V, clearly state your request for mediation by filling in the required fields regarding disciplinary action dates and understanding of appeal rights.
Finally, review all sections for accuracy before signing and dating at the bottom of the form.

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