Whistleblower Form

Whistleblower Form

Note: Fields marked with an * are required.

We advise that whistleblowers use your personal resources and contact information when communicating submitting this form, and that you do not use your work equipment or work contact information. Further, do not submit classified information or other information barred from release through this form or by email.

Various U.S. laws at the federal, state and local level prohibit retaliation against whistleblowers for providing information to Congress. However, you still take serious risks when you report allegations of wrongdoing. We recommend that you consult an attorney experienced in whistleblower law for further guidance. We respect your confidentiality, and we will use your contact information only to follow up with you regarding your submission. You may submit a disclosure anonymously. However, please be aware that anonymous disclosures may limit our ability to respond to the information that you provide.

The Military Whistleblower Protection Act (10 U.S.C. § 1034) prohibits retaliation against a member of the U.S. armed forces who makes, or is perceived as making, a protected disclosure within the scope of the law to an authorized government recipient. It also prohibits restricting a service member from lawfully communicating with an inspector general or a Member of Congress.

The Act’s application within the Department of Defense (DoD) and the military branches is guided by DoD Directive 7050.06. For the Coast Guard, see 33 C.F.R. Part 53.

CLICK HERE FOR MORE INFORMATION ABOUT YOUR PROTECTIONS.

Do not provide classified or sensitive information at this time, as this is an unsecured network. If you have information you would like to further discuss that is or may be sensitive, but unclassified, we will take every precaution to protect that information and can work to secure communications under the appropriate level of security.

CLICK HERE FOR A FACT SHEET FROM THE U.S. OFFICE OF SPECIAL COUNSEL

CONTACT INFORMATION

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Personal Email Address *

Personal Phone Number *

Phone Type *

Voice Videophone [VP] Text-telephone device [TTD]

What are these options?

This is to help the constituents that are hard of hearing or use a video phone alert us to that fact so we can use the proper technology when we need to call them. The default option “Voice” is a normal audible telephone.

Do you have a lawyer for this matter, and do you prefer we communicate through your lawyer? *

Yes, please communicate with me through my lawyer

I have a lawyer, but please communicate with me directly

No, I am not working with a lawyer

Employment Type *

U.S. Federal Government

U.S. Military

U.S. Government Contractor or Grantee

State, Local, or Tribal Government

Private Sector

Retired

Self-Employed

Unemployed

Other (if other, please list)

If you are employed, please list your employer

Please provide your .mil or .gov email address. This will not be used as a means of contact, but for verification purposes *

COMPLAINT DETAILS

Complaint Description (3000 word count limit) *

Please describe your goals in working with Rep. Crenshaw (e.g. oversight, legislative action)? *

Have you filed your concerns elsewhere or contacted another government office about this allegation? *

Yes

No

Do you have colleagues that can support your concerns and are willing to communicate with Rep. Crenshaw? *

Yes

No

Do you believe you have experienced or been threatened with retaliation in connection with your concerns? *

Yes

No

ADDITIONAL INFORMATION

How did you learn about Rep. Crenshaw?

Would you like to be contacted regarding this submission? *

Yes

No

I confirm the information provided is truthful and accurate *

Yes

Human Validation

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