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FAR Contractor Reporting Form

This form is provided as a convenience to contractors for reporting certain violations of Federal criminal and civil law as required under Federal Acquisition Regulation (FAR) contract clause 52.203-13, "Contract Code of Business Ethics and Conduct" (December 2008). Specifically, a contractor may use this form to satisfy the requirement in clause 52.203-13(c)(2)(ii)(F) to timely disclose, in writing, to the 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 report information that does not fall within these guidelines, please visit the our Fraud Hotline.

Official Submitting Disclosure

First Name *

Last Name *

E-Mail *

Confirm E-Mail *

Company Name *

Branch/Division *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal Code *

Country *

Telephone Number 1 *

Telephone Number 2

Fax Number *

Contractor Information

Contract Number *

Contract Type *

Contract Name/Title *

Contract Value *

Description of Services / Supplies / System *

Contract Performance Location *

Contracting Officer Name *

Contracting Officer Address *

Contracting Officer Email *

Contracting Officer Telephone Number *

Contracting Officer's Technical Representative (COTR) *

COTR Address *

COTR Telephone Number *

COTR Email *

Details

Description *

Is the information being provided proprietary or otherwise exempt from public disclosure? *

Yes

If yes, please explain

Has supporting documentation been mailed to DOT/OIG under separate cover? *

Yes

Acknowledgment

Affirm *

I understand and acknowledge that the submission of the foregoing Contractor Disclosure Program submission does not bar, prohibit, foreclose or preclude the Government from pursuing any and all criminal, civil and/or administrative remedies provided to it by law and/or regulation against (a) the business entity(ies) making the forgoing Contractor Disclosure Program submission, (b) any other business entities mentioned in the submission and/or (c) any individuals mentioned in the submission.

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FAR Contractor Reporting Form