FBI Whistleblower Request for Corrective Action Form

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 2023-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1105-0103 FBI Whistleblower Request for Corrective Action Form Form and Instruction
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All Historical Document Collections

202306-1105-001 Approved without change	Extension without change of a currently approved collection	2023-09-29
202009-1105-001 Approved without change	Extension without change of a currently approved collection	2020-09-29
201706-1105-001 Approved without change	New collection (Request for a new OMB Control Number)	2017-08-16