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FBI Whistleblower Request for Corrective Action Form
FBI Whistleblower Request for Corrective Action Form
OMB: 1105-0103
IC ID: 227072
OMB.report
DOJ/LA
OMB 1105-0103
ICR 202406-1105-001
IC 227072
( )
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
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:
Unchanged
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
Federal Enterprise Architecture Business Reference Module
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 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
15
0
0
0
0
15
Annual IC Time Burden (Hours)
45
0
0
0
0
45
Annual IC Cost Burden (Dollars)
0
0
0
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.