This form allows contractors to comply with the reporting requirements in the Federal Acquisition Regulation amendment, 73 Fed. Reg. 67064, effective December 12, 2008. Specifically, contractors may use this form to satisfy the requirement that they notify, in writing, the Office of Inspector General, whenever the contractor has credible evidence that its principal, employee, agent, or subcontractor has committed a violation of the civil False Claims Act or a violation of Federal criminal law involving fraud, conflict of interest, bribery, or gratuities in connection with the award, performance, or closeout of a Department of Homeland Security (DHS) contract or any related subcontract. The individual completing this form must be an authorized representative empowered to speak for the company.
If you wish to provide information that does not fall within these guidelines, please visit the DHS Inspector General Hotline and submit a DHS OIG Investigative Referral Submission Form.
Instructions to complete form:
Fill in the appropriate information in the spaces provided. Appropriately mark any confidential or proprietary information.
Reports also may be submitted to:
DHS Office of Inspector General
Attention: Office of Investigations Hotline
245 Murray Drive SW, Building 410/Mail Stop 2600
Washington, DC 20528
Some of the links on this website require a plug-in to view them. Links to the plug-ins are available below.
Adobe Reader (PDF)