Information Collection

(a) Complaint of Possible Prohibited Personnel Practice or Other Prohibited Activity, (b) Disclosure of Information

IC 35835 under ICR 200910-3255-001 · OMB 3255-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3255-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OSC-11 (a) Complaint of Possible Prohibited Personnel Practice or Other Prohibited Activity, (b) Disclosure of Information	Form
OSC-11 Complaint of Possible Prohibited Personnel Practice OSC Form 11.screen.captures.pdf	Form
OSC-12 Information About Filing a Whistleblower Disclosure with OSC Form 12.Screen.Captures.pdf	Form
OSC Form 13 Complaint of Possible Prohibited Political Activity (Vio osc13.pdf www.osc.gov/forms.htm	Form and Instruction
osc11.pdf OSC Form 11	IC Document
osc12.pdf OSC Form 12	IC Document
OSC can no longer directly accept USERRA complaints.docx Reason for discontinuation of Instrument, OSC Form 14	IC Document

IC Title:

(a) Complaint of Possible Prohibited Personnel Practice or Other Prohibited Activity, (b) Disclosure of Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OSC-11	Complaint of Possible Prohibited Personnel Practice	OSC Form 11.screen.captures.pdf	to be determined once form is in production	Yes	Yes	Fillable Printable
Form	OSC-12	Information About Filing a Whistleblower Disclosure with the Office of Special Counsel	OSC Form 12.Screen.Captures.pdf	To be determined once form goes to production	Yes	Yes	Fillable Printable
Form and Instruction	OSC Form 13	Complaint of Possible Prohibited Political Activity (Violation of the Hatch Act)	osc13.pdf	http://www.osc.gov/forms.htm	Yes	No	Printable Only

Line of Business: Litigation and Judicial Activities

Subfunction: Legal Investigation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,246

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,246	2,246
Annual IC Time Burden (Hours)	2,689	2,689
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OSC Form 11	osc11.pdf	07/10/2008
OSC Form 12	osc12.pdf	07/10/2008
Reason for discontinuation of Instrument, OSC Form 14	OSC can no longer directly accept USERRA complaints.docx	02/20/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.