Information Collection

FBI Whistleblower Request for Corrective Action Form

IC 227072 under ICR 202306-1105-001 · OMB 1105-0103.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1105-0103 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1105-0103 FBI Whistleblower Request for Corrective Action Form	Form and Instruction
1105-0103 FBI Whistleblower Request for Corrective Action Form REQUEST FOR CORRECTIVE ACTION FORM.pdf www.justice.gov/media/1108171/dl?inline	Form and Instruction
1105-0103 FBI Whistleblower Request for Corrective Action Form REQUEST FOR CORRECTIVE ACTION FORM.pdf www.justice.gov/media/1108171/dl?inline	Form and Instruction

IC Title:

FBI Whistleblower Request for Corrective Action Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 and Instruction	1105-0103	FBI Whistleblower Request for Corrective Action Form	REQUEST FOR CORRECTIVE ACTION FORM.pdf	https://www.justice.gov/media/1108171/dl?inline	Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records

Title: JMD-023, Federal Bureau of Investigation Whistleblower Case Files

FR Citation: 72 FR 30631

Number of Respondents: 15

Number of Respondents for Small Entity: 10

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15	5	10
Annual IC Time Burden (Hours)	45	15	30
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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