Nrc Form 835 - Us Nuclear Regulatory Commission Office Of The Inspector General Far Contractor Reporting Form

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NRC FORM 835
U.S. NUCLEAR REGULATORY COMMISSION
(12-2012)
U. S. NUCLEAR REGULATORY COMMISSION
OFFICE OF THE INSPECTOR GENERAL
FAR CONTRACTOR REPORTING FORM
This form is to allow the contractor to notify, in writing, the agency (NRC) Office of the Inspector General,
whenever the contractor has credible evidence that a principal, employee, agent, or subcontractor of the
contractor has committed a violation of the Civil False Claims Act or a violation of Federal criminal law
involving fraud, conflict of interest, bribery, or gratuity violations in connection with the award, performance, or
closeout of a contract or any related subcontract. The individual completing this form must be an officer or
manager empowered to speak for the company by filing this report.
Please print a copy of this form for your records before faxing or mailing. Mandatory fields are denoted with
an asterisk (*).
If you wish to provide information that does not fall within these guidelines, please visit the OIG Hotline Web
Site at
Your Disclosure Information:
Instructions:
Your first name*
Fill in, print, and sign the form.
Send by mail or facsimile to:
Your last name*
Your title*
U. S. Nuclear Regulatory Commission
Your business e-mail*
Office of the Inspector General
Attention: FAR Contractor Reporting
Confirm your business e-mail*
11555 Rockville Pike - MS O-5E13
Rockville, MD 20852
Your telephone number*
Fax - (301) 415-5091
Company Information
Name of Company *
Company President or Director *
Affected Corporate Branch *
Doing Business As *
Business Address *
City, State, and Zip Code *
Country *
Telephone *
Fax Number *
Web Site *
Page 1 of 3
NRC FORM 835 (12-2012)

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