Information Collection

OSC Complaint Forms 11,12 and 13

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OSC Form 12 Whistleblower Disclosure Form OSC Complaint Forms 11,12 and 13	Form
Form OSC Form 11 Complaint of Possible Prohibited Personnel Practice OSC Complaint Forms 11,12 and 13	Form
Form OSC Form 13 Complaint of Possible Prohibited Political Activity (Violation of the Hatch Act) 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

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OSC Form 12	https://osc.gov/pages/file-complaint.aspx	Yes	Yes	Fillable Fileable Signable
Form	OSC Form 11	https://osc.gov/pages/file-complaint.aspx	Yes	Yes	Fillable Fileable Signable
Form	OSC Form 13	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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement for OSC Forms 11,12&13		05/29/2015

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

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