Your request for corrective action must be as specific and factually detailed as possible, and it must contain:
Personal Information
- Your name, address, telephone number, and e-mail address, as well as that of your designated representative (if any);
- Your signature and the signature of your designated representative (if any); and
- The title and location of your current/former position at the FBI at the time you made your whistleblower disclosure, including whether you are/were in a career or non-career position; or, if you are an applicant for employment with the FBI, the title of the position(s) for which you applied.
Evidence of Exhaustion
- Evidence that you sought corrective action involving the same protected disclosure(s) and personnel action(s) from the Conducting Office (i.e., either the Department of Justice's Office of Professional Responsibility or Office of the Inspector General), including the date on which you filed a reprisal complaint with the Conducting Office and an indication as to whether you received notice from the Conducting Office of its termination of its investigation of your reprisal claims; and
- Any letter you received from the Conducting Office notifying you that it terminated its investigation of your reprisal complaint (the Conducting Office's termination letter is not admissible in OARM proceedings without your consent; you may redact or refrain from submitting all portions other than the date and the first paragraph identifying the letter as a termination letter).
Your Reprisal Claim
- A detailed description of your alleged whistleblower disclosure(s), including the date of each disclosure and name and title of each individual or office to whom each disclosure was made;
- An indication as to whether you made a disclosure which you believe evidenced any violation of any law, rule, or regulation; gross mismanagement; a gross waste of funds; an abuse of authority; and/or a substantial and specific danger to public health or safety;
- A chronology of facts concerning each alleged personnel action taken against you, including the date of each action and the name and title of the person(s) responsible for each action;
- An explanation of why you believe the personnel action was taken in reprisal for your whistleblower activity and any supporting evidence you have; and
- An indication as to whether the FBI official(s) who took the alleged personnel action(s) against you had knowledge of your disclosure (if so, specify the date on which you believe each official learned of your disclosure, and explain why you believe each official had knowledge of your disclosure).
Relief Sought
An explanation of the specific remedy or relief sought.
Privacy Act Statement This information is provided pursuant to the Privacy Act of 1974, 5 U.S.C. § 552a(e)(3): OARM requests personal information that is relevant and necessary to reach a decision on your request for corrective action. OARM collects this information in order to adjudicate requests for corrective action brought pursuant to the FBI whistleblower regulations, 28 C.F.R. part 27. OARM has the authority to ask for this information pursuant to 5 U.S.C. § 301, 44 U.S.C. § 3101, and 28 C.F.R. part 27. Because your request for corrective action is a voluntary action, you are not required to provide any personal information in connection with it. However, your failure to supply OARM with all of the information essential to reach a decision in your case could result in the rejection of your request for corrective action. The information you provide is maintained in the JMD-023, Federal Bureau of Investigation Whistleblower Case Files system of records, 70 Fed. Reg. 53,253 (Sept. 7, 2005), as amended 72 Fed. Reg. 3410 (Jan. 25, 2007), 72 Fed. Reg. 15,906 (Apr. 3, 2007), and 72 Fed. Reg. 30,631 (June 1, 2007). If you supply OARM with your information, your information may be disclosed by the Department of Justice in accordance with the provisions of the Privacy Act, including to contractors, grantees, experts, consultants, and others performing or working on a contract, service, grant, cooperative agreement, or other assignment for the Federal Government when necessary to accomplish an agency function related to this system of records, to the National Archives and Records Administration in connection with records retention or disposition issues, or for other routine uses indicated in the JMD-023, Federal Bureau of Investigation Whistleblower Case Files system of records notice. To view the routine uses applicable to this system of records, please consult the system of records notice, as amended, at the following links: 70 Fed. Reg. 53,253 at https://www.gpo.gov/fdsys/pkg/FR-2005-09-07/pdf/05-17700.pdf; 72 Fed. Reg. 3410 at https://www.gpo.gov/fdsys/pkg/FR-2007-01-25/pdf/E7-1176.pdf; 72 Fed. Reg. 15,906 at https://www.gpo.gov/fdsys/pkg/FR-2007-04-03/pdf/E7-6108.pdf; 72 Fed. Reg. 30,631 at https://www.gpo.gov/fdsys/pkg/FR-2007-06-01/pdf/E7-10523.pdf.
