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Department of Labor
Office of Inspector General
Contractor Disclosure Form

The Federal Acquisition Regulation (“FAR”) now requires all contractors to notify the government whenever they become aware of a contract overpayment or fraud.  If you are a federal contractor, or employee of same, and you have evidence of a violation of Federal law involving fraud, conflict of interest, bribery, gratuity violations, or violations of the False Claims Act, please complete and submit this form.


Section A: Official Submitting Disclosure

Section B: Contractor Information

Section C: Disclosure Information

I am reporting on the following contract:

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   - DOL Contracting Officer Name:


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$

 

I am reporting on the following incident involving the above contract:

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$

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Additional Incident Attributes: does the incident you are reporting involve any of the following:

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Full Description:

Please provide a complete description of the facts and circumstances surrounding the reported activities, including the evidence forming the basis of this report, the name of the individuals involved, dates, location, how the matter was discovered, potential witnesses and their involvement, and any corrective action taken by the company.

Section D: Certification and Confirmation

By clicking the "submit" button below, I certify under penalty of perjury that the information contained herein is true and correct to the best of my knowledge as of the date of this submission.

After clicking the “submit” button below, you will be provided with a “confirmation number” in reference to this disclosure submission

 

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