Contractor Fraud Reporting Form for OIG

To implement the FAR rule on Contractor Disclosures (effective December 12th, 2008), this form has been created to assist the Contractor in notifying the USDA 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. If you wish to provide information that does not fall within these guidelines, please visit the Office of Inspector General, USDA web site at and/or e-mail the USDA OIG hotline at ""

Company Information
Contract Information
Incident Reporting

Please provide a complete description of the facts and circumstances surrounding the reported activities, including the evidence forming the basis of this report, the names of the individuals involved, dates, location, how the matter was discovered, potential witnesses and their involvement and any corrective action taken by the company.
NOTE: Please provide the names, email contact, and business phone for any individuals involved and/or potential witnesses.
Is the information being provided confidential, proprietary, or otherwise exempt from public disclosure?
Certification (* denotes required field)

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