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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.