OMB control number
FBI Whistleblower Request for Corrective Action Form
OMB 1105-0103 ยท DOJ/LA.
OMB 1105-0103
The information collected on this form is necessary for OARM to adjudicate respondent's whistleblower reprisal claims. Respondents are current or former FBI employees or applicants for employment with the FBI.
The latest form for FBI Whistleblower Request for Corrective Action Form expires 2026-11-30 and is listed under ICR 202406-1105-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 1105-0103 FBI Whistleblower Request for Corrective Action Form | Form and Instruction |
| RCA Form (with non-substantive changes).pdf | Supplementary Document |
| Justification for a Non-Material-Nonsubstantive Change (OMB 1105-0103).pdf | Justification for No Material/Nonsubstantive Change |
| Fed Register 30 Day Notice August 24 2023.pdf | Supplementary Document |
| 28 CFR Part 27 (up to date as of 6-12-2023).pdf | Supplementary Document |
| 5 U.S.C. 2303.pdf | Supplementary Document |
| Fed Register 60 day notice - May 24-2023 1105-0103.pdf | Supplementary Document |
 2023 PRA Supporting Statement (FBI WB RCA).docx | Supporting Statement A |
 FBI Whistleblower Request for Corrective Action Form |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202406-1105-001 | No material or nonsubstantive change to a currently approved collection | 2024-06-04 | Approved without change | |
| 202306-1105-001 | Extension without change of a currently approved collection | 2023-09-29 | Approved without change | |
| 202009-1105-001 | Extension without change of a currently approved collection | 2020-09-29 | Approved without change | |
| 201706-1105-001 | New collection (Request for a new OMB Control Number) | 2017-08-16 | Approved without change |