Whistleblower Reprisal Complaint Form printable pdf download

Fraud, Waste and Abuse

Whistleblower Reprisal Complaint Form

(*) Required information

PART I - Your Information

Use this form only to file complaints of whistleblower reprisal. If you are unsure as to whether your complaint meets the

criteria for a whistleblower reprisal complaint, please review the background information provided on the DoD IG reprisal

webpage at Only the individual reprised against can file whistleblower

reprisal complaints. If your complaint does not meet the requirements for whistleblower reprisal, please file your complaint as

a Fraud, Waste, or Abuse complaint with the DoD Hotline at If you are an appropriated fund

civilian employee and your complaint alleges reprisal due to race, color, sex, national origin, religion, disability, or genetic

information, or you feel you have been retaliated against for filing an earlier complaint with EEO, then please file your

complaint

with

your

EEO

office

the

Equal

Employment

Opportunity

Commission,

not

the

DoD

Inspector General.

I have reviewed the criteria for a whistleblower reprisal complaint and this complaint meets the

criteria:*

Yes

No (If no, do not continue with this form)

I am the person who was reprised

against:*

Yes

No (If no, do not continue with this form)

Due to the unique and personal nature of whistleblower reprisal cases, your name and contact information (identity) has to be

made available to the appropriate investigating agency, which may be an IG office outside of DoD IG. If you do not elect to

release your identity, processing of your complaint will not continue beyond that point. If at a later date you do decide to

release your identity, a new complaint can be filed at that time.

Please Select

One*

RELEASE OF IDENTITY (I give permission for DoD Hotline to release my name and contact information outside the

DoD Hotline on a need-to-know basis.)

NON-RELEASE OF IDENTITY (I do NOT give permission to DoD Hotline to provide my name and contact information

outside the DoD Hotline. I understand that processing of my complaint will not continue beyond this point.)

Department of Defense Hotline

The Pentagon

Washington,D.C. 20301-1900

FWAHotline: (800)424-9098

SWA Hotline: (877) 363-3348

Hotline Fax: (703) 604-8567

Whistleblower Reprisal Complaint Form

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