After completing this form, please save the form, print it and fax it to 202-254-4297 This email address is being protected from spambots. You need JavaScript enabled to view it! The Office of the Inspector General may contact you for additional information or supporting documentation. Fill out the form below. If you are unsure whether this form applies or if you have any questions, please call the OIG hotline at 800-409-9926 and enter the appropriate information in the fields provided. Appropriately label confidential or proprietary information. This form allows contractors to comply with the reporting requirements of the Federal Acquisition Regulation Amendment, 73 Fed. Reg. 67064, with effect from 12 December 2008. In particular, contractors may use this form to satisfy the requirement that they notify the Office of the Inspector General in writing if the contractor has credible evidence that its principal, employee, agent or subcontractor has committed a civil law violation on false claims or a violation of federal criminal law that involves fraud, conflicts of interest, bribery, or gratuities related to the award, performance, or conclusion of a Department of Homeland Security (DHS) contract or related subcontract.
The person completing this form must be a representative authorized to speak on behalf of the company. The purpose of this form is to allow the Contractor to notify the Office of the Inspector General of the Agency in writing if the Contractor has credible evidence that a Contractor, employee, agent or subcontractor of the Contractor has committed a violation of the Civil Code on false claims or a violation of the Civil Code in connection with the award or performance of a contract or any related subcontract. Federal criminal law. The person completing this form must be an officer or manager of the business for which this report is being prepared and must be authorized to speak on behalf of the business when submitting this report. If the information you wish to provide is not covered by this policy, please refer to the Inspector General`s Hotline/Fraud Reporting Form. If you would like to provide information that is not covered by these guidelines, please visit the DHS Inspector General`s Hotline and submit a DHS Office of the Inspector General`s Investigation Recommendation Request Form. DhS Office of the Inspector General Attn: Office of Investigation Hotline245 Murray Drive SW, Building 410/Mail Stop 2600Washington, DC 20528 You can also write to : . .