Whistleblower Program Forms

This information collection request (ICR) relates to three new forms necessary for the efficient operation of the National Highway Traffic Safety Administration’s (NHTSA) whistleblower program, as established by 49 U.S.C. § 30172 (the Whistleblower Act). The Whistleblower Act authorizes the Secretary of Transportation (the Secretary) to pay an award to eligible whistleblowers who voluntarily provide original information, if the information provided leads to the successful resolution of a covered action. The three forms are the WB-INFO form, the WB-AWARD form, and the WB-RELEASE form. All of the information collections are collected on an as-needed basis. One of the information collections is completely voluntary and the other two are voluntary, but required to receive a benefit. Under the final rule, a potential whistleblower is required to submit a WB-INFO form and to submit a WB-AWARD form in order to qualify for a whistleblower award. A potential whistleblower may choose to voluntarily submit the WB-RELEASE form. Only minor changes, for clarity, were made to the forms in the final rule. The WB-INFO form will be used to permit NHTSA and its staff to collect information from potential whistleblowers about themselves, their legal representatives, and their allegations relating to any potential violation of the Safety Act or regulation thereunder. If a potential whistleblower proceeds anonymously, the individual must have a legal representative. That legal representative will retain their client’s signed WB-INFO form. The WB-AWARD form will permit NHTSA to collect information relating to a claimant’s eligibility for an award. This will allow NHTSA’s Administrator to determine claims for whistleblower awards. The WB-RELEASE form will provide a means for the potential whistleblower to provide consent for NHTSA to disclose information which could reasonably be expected to reveal the identity of the potential whistleblower. Being able to disclose this information may allow NHTSA to open a public investigation or proceed more efficiently with an investigation into the potential whistleblower’s allegations. The likely respondents to the forms (the WB-INFO, the WB-AWARD, and the WB-RELEASE form) are those employees or contractors of motor vehicle manufacturers, part suppliers, and dealerships who wish to provide NHTSA with information relating to any potential motor vehicle defect, potential noncompliance, or any violation or alleged violation of any notification or reporting requirement of the Safety Act or regulation thereunder. The anticipated recipients of the WB-INFO, WB-AWARD and WB-RELEASE forms are those individuals at NHTSA who have a need to know the information. This may include attorneys in NHTSA’s Office of the Chief Counsel and staff in NHTSA’s Office of Enforcement.

The latest form for Whistleblower Program Forms expires 2028-01-31 and can be found here.

WB-INFO-Individual

Federal Enterprise Architecture: Transportation - Ground Transportation

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.