Information Collection

OSC Complaint Forms 11,12 and 13

IC 214485 under ICR 201501-3255-003 · OMB 3255-0004.

Documents and Forms

Document Name Document Type
Form OSC Form 12 OSC Complaint Forms 11,12 and 13 Form
OSC Form 12 Whistleblower Disclosure Form osc12.pdf osc.gov/pages/file-complaint.aspx Form
OSC Form 11 Complaint of Possible Prohibited Personnel Practice osc11.pdf osc.gov/pages/file-complaint.aspx Form
OSC Form 13 Complaint of Possible Prohibited Political Activity (Vio osc13.pdf osc.gov/pages/file-complaint.aspx Form
Supporting Statement A for OSC Forms 11, 12, and 13.doc Supporting Statement for OSC Forms 11,12&13 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	OSC Complaint Forms 11,12 and 13	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 1320

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OSC Form 12	Whistleblower Disclosure Form	osc12.pdf	https://osc.gov/pages/file-complaint.aspx	Yes	Yes	Fillable Fileable Signable
Form	OSC Form 11	Complaint of Possible Prohibited Personnel Practice	osc11.pdf	https://osc.gov/pages/file-complaint.aspx	Yes	Yes	Fillable Fileable Signable
Form	OSC Form 13	Complaint of Possible Prohibited Political Activity (Violation of the Hatch Act)	osc13.pdf	https://osc.gov/pages/file-complaint.aspx	Yes	No	Printable Only

Line of Business: Litigation and Judicial Activities

Subfunction: Legal Investigation

Privacy Act System of Records
Title: OSC/GOVT-1, OSC Complaint, Litigation, Political Activity, and Disclosure Files	FR Citation: 77 FR 24242

Number of Respondents: 5,076	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 85 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,076	5,076
Annual IC Time Burden (Hours)	6,232	6,232
Annual IC Cost Burden (Dollars)	51	51

Documents for IC

Title	Document	Date Uploaded
Supporting Statement for OSC Forms 11,12&13	Supporting Statement A for OSC Forms 11, 12, and 13.doc	05/29/2015

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