OPTIONAL EMPLOYEE DISCLOSURE FORM DEPARTMENT OF VETERANS AFFAIRS OFFICE OF ACCOUNTABILITY AND WHISTLEBLOWER PROTECTION Purpose: This form is to provide employees with an optional method of submitting.
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How to fill out the VA Form 10177, Employee Disclosure Form online
The VA Form 10177, Employee Disclosure Form, provides a vital opportunity for employees to submit disclosures regarding potential wrongdoing or violations within the Department of Veterans Affairs. This guide will assist you in filling out the form online in a clear and straightforward manner.
Follow the steps to complete the form with ease.
- Press the ‘Get Form’ button to access the form and open it in your editor.
- Provide the date of submission in the designated field. This marks the official date of your disclosure.
- In Part 1, fill in your personal information. Enter your name, optional mailing address, and contact numbers (home, office, and cell). Include your email address, current position title, series, grade, and the name and address of the VA facility where you are employed.
- In Part 2, specify the name of the VA facility where the activity you are disclosing occurred, along with its address.
- Move to Part 3, where you will detail your disclosure. Indicate how you know about the information you are disclosing (personal knowledge, information from other employees, or other sources). Identify the facility and organizational unit involved.
- In Part 3, check all applicable types of agency wrongdoing you are alleging. If you select 'violation of law, rule, or regulation,' provide the specific details if possible.
- Clearly describe the agency wrongdoing in the designated area, providing specific information about dates, locations, and the identities and positions of involved individuals. If you have any supporting documents, note them here.
- In Part 4, choose whether you consent to the release of your identity. Provide an ink signature and the date you submitted the form.
- Ensure all attached documents are noted in the space provided to create a complete submission package.
Begin filling out the VA Form 10177 online to submit your disclosure today.
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Get answers to your most pressing questions about US Legal Forms API.
What is the purpose of a report of contact?
A contact report is a record of a meeting, conversation, and/or correspondence between development staff and a prospect.
What is the whistleblower law in VA?
The Virginia whistleblower law provides potential remedies for employees who have been retaliated against for their protected activity. Specifically, the whistleblower law provides for injunctions, reinstatement, compensation for lost wages and benefits, and reasonable attorney fees and costs.
What is VA Form 119 used for?
a. Purpose of VA Form 119. have future use to justify or disprove allegations that information given by the VA employee was incorrect, incomplete, or otherwise not in ance with law, regulations, or procedures.
Where can I download VA forms?
VA forms are available at .va.gov/vaforms. A separate expedited claims processing program available for current active duty Servicemembers is explained on page 5 under Compensation Claims Submitted Prior to Discharge.
What is Form 119 report of contact?
What is a VA Form 119? The main purpose of the VA Report of Contact form is to document discussions that contain potentially controversial questions between the VA employees and claimants, their representatives, or other individuals.
What is considered whistleblower retaliation?
The Whistleblower Protection Act (WPA) was established to ensure that employees who engage in protected disclosure are free from fear of reprisal for their disclosures. Whistleblower retaliation is the taking, failing to take, or threatening to take a personnel action because of an employee's whistleblowing.
How long does it take a BVA judge to make a decision?
The Veterans Benefits Administration usually takes 12 to 18 months to review appeals and decide whether to grant some or all of the appeal. When you request a review from a Veterans Law Judge at the Board of Veterans' Appeals, it could take 5 to 7 years for you to get a decision.
What form does a doctor need to fill out for VA disability?
Use VA Form 21-4142 to give us permission to obtain your personal information from a non-VA source like a private doctor or hospital. Examples of personal information may include your medical treatment, hospitalizations, psychotherapy, or outpatient care.
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