www.hudoig.gov
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2606:4700::6812:1fcc
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URL:
https://www.hudoig.gov/hotline/whistleblower-retaliation-complaint-form
Submission: On August 26 via api from US — Scanned from DE
Submission: On August 26 via api from US — Scanned from DE
Form analysis 2 forms found in the DOM
GET /search
<form action="/search" method="get" id="search-block-form" accept-charset="UTF-8" class="search-form search-block-form form-row" data-drupal-form-fields="edit-keys" data-once="form-updated">
<fieldset class="js-form-item js-form-type-search form-type-search js-form-item-keys form-item-keys form-no-label form-group col-auto">
<label for="edit-keys" class="sr-only">Search</label>
<input title="Enter the terms you wish to search for." data-drupal-selector="edit-keys" type="search" id="edit-keys" name="search_api_fulltext" value="" size="15" maxlength="128" class="form-search form-control">
</fieldset>
<div data-drupal-selector="edit-actions" class="form-actions js-form-wrapper form-group col-auto" id="edit-actions">
<button data-drupal-selector="edit-submit" type="submit" id="edit-submit" value="Search" class="button js-form-submit form-submit btn btn-primary">
<svg class="svg-inline--fa fa-search fa-w-16" aria-hidden="true" focusable="false" data-prefix="fas" data-icon="search" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" data-fa-i2svg="">
<path fill="currentColor"
d="M505 442.7L405.3 343c-4.5-4.5-10.6-7-17-7H372c27.6-35.3 44-79.7 44-128C416 93.1 322.9 0 208 0S0 93.1 0 208s93.1 208 208 208c48.3 0 92.7-16.4 128-44v16.3c0 6.4 2.5 12.5 7 17l99.7 99.7c9.4 9.4 24.6 9.4 33.9 0l28.3-28.3c9.4-9.4 9.4-24.6.1-34zM208 336c-70.7 0-128-57.2-128-128 0-70.7 57.2-128 128-128 70.7 0 128 57.2 128 128 0 70.7-57.2 128-128 128z">
</path>
</svg><!-- <i class="fas fa-search"></i> -->
</button>
</div>
</form>POST /hotline/whistleblower-retaliation-complaint-form
<form class="webform-submission-form webform-submission-add-form webform-submission-hotline-whistleblower-form-form webform-submission-hotline-whistleblower-form-add-form js-webform-details-toggle webform-details-toggle"
data-drupal-selector="webform-submission-hotline-whistleblower-form-add-form" action="/hotline/whistleblower-retaliation-complaint-form" method="post" id="webform-submission-hotline-whistleblower-form-add-form" accept-charset="UTF-8"
data-once="form-updated"
data-drupal-form-fields="edit-complainant-self-identification,edit-first-name,edit-last-name,edit-complainant-address-1-,edit-complainant-address-2-,edit-complainant-city-,edit-complainant-state-,edit-complainant-zip-,edit-complainant-phone-,edit-complainant-email,edit-complainant-dob,edit-preferred-method-of-contact,edit-specific-date-,edit-when-date-,edit-date-range-,edit-add-first-witness-,edit-witness-1-first-name-,edit-witness-1-last-name-,edit-witness-1-address-1-,edit-witness-1-address-2-,edit-witness-1-city-,edit-witness-1-state-,edit-witness-1-zip-,edit-witness-1-phone-,edit-add-second-witness-,edit-witness-2-first-name-,edit-witness-2-last-name-,edit-witness-2-address-1-,edit-witness-2-address-2-,edit-witness-2-city-,edit-witness-2-state-,edit-witness-2-zip-,edit-witness-2-phone-,edit-state-your-position-at-hud-,edit-dates-of-employment-at-hud-,edit-state-the-name-of-your-employer-,edit-state-your-employer-s-relationship-with-hud-programs-,edit-state-your-position-at-the-employer-,edit-state-your-dates-of-employment-at-the-employer-,edit-state-the-nature-of-the-violation-re-hud-programs-that-you-discl,edit-how-become-aware,edit-provide-name-role,edit-what-and-when-occured,edit-who-took-personnel,edit-relationship,edit-person-s-knowledge,edit-any-other-process,edit-actions-submit">
<fieldset data-drupal-selector="edit-complainant-information" id="edit-complainant-information" class="js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3">
<legend>
<span class="fieldset-legend">COMPLAINANT INFORMATION</span>
</legend>
<div class="fieldset-wrapper">
<fieldset class="col-md-6 js-form-item js-form-type-select form-type-select js-form-item-complainant-self-identification form-item-complainant-self-identification mb-3">
<label for="edit-complainant-self-identification" class="js-form-required form-required">You are a:</label>
<select data-drupal-selector="edit-complainant-self-identification" id="edit-complainant-self-identification" name="complainant_self_identification" class="form-select required" required="required" aria-required="true">
<option value="" selected="selected">- Select -</option>
<option value="HUD Employee">HUD Employee</option>
<option value="HUD OIG Employee">HUD OIG Employee</option>
<option value="HUD Contractor">HUD Contractor</option>
<option value="Program Participant">Program Participant</option>
<option value="Concerned Citizen">Concerned Citizen</option>
</select>
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-first-name form-item-first-name mb-3">
<label for="edit-first-name" class="js-form-required form-required">Your First Name:</label>
<input class="col-md-6 js-webform-counter webform-counter required form-control" data-counter-type="character" data-counter-minimum="1" data-counter-maximum="30"
data-counter-maximum-message="field can not be longer than 30 characters (this includes spaces)" minlength="1" data-drupal-selector="edit-first-name" type="text" id="edit-first-name" name="first_name" value="" size="60" maxlength="30"
required="required" aria-required="true">
<div class="text-count-wrapper">
<div class="text-count-message" aria-live="assertive" aria-atomic="true" style="display: inline;">field can not be longer than 30 characters (this includes spaces)</div>
<div class="text-count-overflow-wrapper" style="display: none;"></div>
</div>
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-last-name form-item-last-name mb-3">
<label for="edit-last-name" class="js-form-required form-required">Your Last Name:</label>
<input class="col-md-6 js-webform-counter webform-counter required form-control" data-counter-type="character" data-counter-minimum="1" data-counter-maximum="30"
data-counter-maximum-message="field can not be longer than 30 characters (this includes spaces)" minlength="1" data-drupal-selector="edit-last-name" type="text" id="edit-last-name" name="last_name" value="" size="60" maxlength="30"
required="required" aria-required="true">
<div class="text-count-wrapper">
<div class="text-count-message" aria-live="assertive" aria-atomic="true" style="display: inline;">field can not be longer than 30 characters (this includes spaces)</div>
<div class="text-count-overflow-wrapper" style="display: none;"></div>
</div>
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-complainant-address-1- form-item-complainant-address-1- mb-3">
<label for="edit-complainant-address-1-">Your Address 1:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-complainant-address-1-" type="text" id="edit-complainant-address-1-" name="complainant_address_1_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-complainant-address-2- form-item-complainant-address-2- mb-3">
<label for="edit-complainant-address-2-">Your Address 2:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-complainant-address-2-" type="text" id="edit-complainant-address-2-" name="complainant_address_2_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-complainant-city- form-item-complainant-city- mb-3">
<label for="edit-complainant-city-">Your City:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-complainant-city-" type="text" id="edit-complainant-city-" name="complainant_city_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="col-md-6 js-form-item js-form-type-select form-type-select js-form-item-complainant-state- form-item-complainant-state- mb-3">
<label for="edit-complainant-state-">Your State:</label>
<select data-drupal-selector="edit-complainant-state-" id="edit-complainant-state-" name="complainant_state_" class="form-select select2-hidden-accessible" data-select2-id="edit-complainant-state-" tabindex="-1" aria-hidden="true">
<option value="" selected="selected" data-select2-id="2">- None -</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="1" style="width: 501.062px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-labelledby="select2-edit-complainant-state--container"><span class="select2-selection__rendered" id="select2-edit-complainant-state--container"
role="textbox" aria-readonly="true" title="- None -">- None -</span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper"
aria-hidden="true"></span></span>
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-complainant-zip- form-item-complainant-zip- mb-3">
<label for="edit-complainant-zip-">Your Zip:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-complainant-zip-" type="text" id="edit-complainant-zip-" name="complainant_zip_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="col-md-6 js-form-item js-form-type-textfield form-type-textfield js-form-item-complainant-phone- form-item-complainant-phone- mb-3">
<label for="edit-complainant-phone-">Your Phone:</label>
<input data-drupal-selector="edit-complainant-phone-" type="text" id="edit-complainant-phone-" name="complainant_phone_" value="" size="60" maxlength="255" class="form-control">
</fieldset>
<fieldset class="col-md-6 js-form-item js-form-type-email form-type-email js-form-item-complainant-email form-item-complainant-email mb-3">
<label for="edit-complainant-email">Your Email:</label>
<input data-drupal-selector="edit-complainant-email" type="email" id="edit-complainant-email" name="complainant_email" value="" size="60" maxlength="254" class="form-email form-control">
</fieldset>
<fieldset class="col-md-6 js-form-item js-form-type-date form-type-date js-form-item-complainant-dob form-item-complainant-dob mb-3">
<label for="edit-complainant-dob">Your Date of Birth:</label>
<input type="date" data-drupal-selector="edit-complainant-dob" data-drupal-date-format="Y-m-d" id="edit-complainant-dob" name="complainant_dob" value="" class="form-date form-control">
</fieldset>
<fieldset class="col-md-6 js-form-item js-form-type-select form-type-select js-form-item-preferred-method-of-contact form-item-preferred-method-of-contact mb-3">
<label for="edit-preferred-method-of-contact">Preferred Method of Contact</label>
<select data-drupal-selector="edit-preferred-method-of-contact" id="edit-preferred-method-of-contact" name="preferred_method_of_contact" class="form-select">
<option value="" selected="selected">- None -</option>
<option value="Address">Address</option>
<option value="Email Address">Email Address</option>
<option value="Phone Number">Phone Number</option>
</select>
</fieldset>
</div>
</fieldset>
<fieldset data-drupal-selector="edit-when-did-this-occur-" id="edit-when-did-this-occur-" class="js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3">
<legend>
<span class="fieldset-legend">WHEN DID THIS OCCUR?</span>
</legend>
<div class="fieldset-wrapper">
<fieldset class="col-md-6 js-form-item js-form-type-select form-type-select js-form-item-specific-date- form-item-specific-date- mb-3">
<label for="edit-specific-date-">Specific Date?</label>
<select data-drupal-selector="edit-specific-date-" id="edit-specific-date-" name="specific_date_" class="form-select">
<option value="" selected="selected">- None -</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</fieldset>
<fieldset class="col-md-6 js-webform-states-hidden js-form-item js-form-type-date form-type-date js-form-item-when-date- form-item-when-date- mb-3"
data-drupal-states="{"visible":{":input[name=\u0022specific_date_\u0022]":{"value":"Yes"}}}" style="display: none;">
<label for="edit-when-date-">Date:</label>
<input min="2020-08-25" data-min-year="2020" max="2024-08-25" data-max-year="2024" type="date" data-drupal-selector="edit-when-date-" data-drupal-date-format="Y-m-d" id="edit-when-date-" name="when_date_" value=""
class="form-date form-control" data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022specific_date_\u0022]":{"value":"Yes"}}}">
</fieldset>
<fieldset class="js-webform-states-hidden js-form-item js-form-type-textarea form-type-textarea js-form-item-date-range- form-item-date-range- mb-3" style="display: none;">
<label for="edit-date-range-">Date Range:</label>
<div class="form-textarea-wrapper">
<textarea data-counter-type="character" data-counter-maximum="10000" class="js-webform-counter webform-counter form-textarea form-control resize-vertical" data-drupal-selector="edit-date-range-"
data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022specific_date_\u0022]":{"value":"No"}}}" id="edit-date-range-" name="date_range_" rows="5"
cols="60" maxlength="10000"></textarea>
<div class="text-count-wrapper">
<div class="text-count-message" aria-live="assertive" aria-atomic="true" style="display: inline;"><span class="text-count">10000</span> character(s) remaining</div>
<div class="text-count-overflow-wrapper" style="display: none;"></div>
</div>
</div>
</fieldset>
</div>
</fieldset>
<fieldset class="col-md-4 js-form-item js-form-type-select form-type-select js-form-item-add-first-witness- form-item-add-first-witness- mb-3">
<label for="edit-add-first-witness-">Add a witness?</label>
<select data-drupal-selector="edit-add-first-witness-" id="edit-add-first-witness-" name="add_first_witness_" class="form-select">
<option value="" selected="selected">- None -</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</fieldset>
<fieldset class="js-webform-states-hidden js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3" data-drupal-selector="edit-witness-1"
data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022add_first_witness_\u0022]":{"value":"Yes"}}}" id="edit-witness-1" style="display: none;">
<legend>
<span class="fieldset-legend">WITNESS 1</span>
</legend>
<div class="fieldset-wrapper">
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-1-first-name- form-item-witness-1-first-name- mb-3">
<label for="edit-witness-1-first-name-">Witness 1 - First Name:</label>
<input class="col-md-6 js-webform-counter webform-counter form-control" data-counter-type="character" data-counter-minimum="1" data-counter-maximum="30"
data-counter-maximum-message="field can not be longer than 30 characters (this includes spaces)" minlength="1" data-drupal-selector="edit-witness-1-first-name-" type="text" id="edit-witness-1-first-name-" name="witness_1_first_name_"
value="" size="60" maxlength="30" data-drupal-states="{"required":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022add_first_witness_\u0022]":{"value":"Yes"}}}">
<div class="text-count-wrapper">
<div class="text-count-message" aria-live="assertive" aria-atomic="true" style="display: inline;">field can not be longer than 30 characters (this includes spaces)</div>
<div class="text-count-overflow-wrapper" style="display: none;"></div>
</div>
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-1-last-name- form-item-witness-1-last-name- mb-3">
<label for="edit-witness-1-last-name-">Witness 1 - Last Name:</label>
<input class="col-md-6 js-webform-counter webform-counter form-control" data-counter-type="character" data-counter-minimum="1" data-counter-maximum="30"
data-counter-maximum-message="field can not be longer than 30 characters (this includes spaces)" minlength="1" data-drupal-selector="edit-witness-1-last-name-" type="text" id="edit-witness-1-last-name-" name="witness_1_last_name_" value=""
size="60" maxlength="30" data-drupal-states="{"required":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022add_first_witness_\u0022]":{"value":"Yes"}}}">
<div class="text-count-wrapper">
<div class="text-count-message" aria-live="assertive" aria-atomic="true" style="display: inline;">field can not be longer than 30 characters (this includes spaces)</div>
<div class="text-count-overflow-wrapper" style="display: none;"></div>
</div>
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-1-address-1- form-item-witness-1-address-1- mb-3">
<label for="edit-witness-1-address-1-">Witness 1 - Address 1:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-witness-1-address-1-" type="text" id="edit-witness-1-address-1-" name="witness_1_address_1_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-1-address-2- form-item-witness-1-address-2- mb-3">
<label for="edit-witness-1-address-2-">Witness 1 - Address 2:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-witness-1-address-2-" type="text" id="edit-witness-1-address-2-" name="witness_1_address_2_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-1-city- form-item-witness-1-city- mb-3">
<label for="edit-witness-1-city-">Witness 1 - City:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-witness-1-city-" type="text" id="edit-witness-1-city-" name="witness_1_city_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="col-md-6 js-form-item js-form-type-select form-type-select js-form-item-witness-1-state- form-item-witness-1-state- mb-3">
<label for="edit-witness-1-state-">Witness 1 - State:</label>
<select data-drupal-selector="edit-witness-1-state-" id="edit-witness-1-state-" name="witness_1_state_" class="form-select">
<option value="" selected="selected">- None -</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select>
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-1-zip- form-item-witness-1-zip- mb-3">
<label for="edit-witness-1-zip-">Witness 1 - Zip:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-witness-1-zip-" type="text" id="edit-witness-1-zip-" name="witness_1_zip_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="col-md-6 js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-1-phone- form-item-witness-1-phone- mb-3">
<label for="edit-witness-1-phone-">Witness 1 - Phone:</label>
<input data-drupal-selector="edit-witness-1-phone-" type="text" id="edit-witness-1-phone-" name="witness_1_phone_" value="" size="60" maxlength="255" class="form-control">
</fieldset>
<fieldset class="col-md-4 js-form-item js-form-type-select form-type-select js-form-item-add-second-witness- form-item-add-second-witness- mb-3">
<label for="edit-add-second-witness-">Add another witness?</label>
<select data-drupal-selector="edit-add-second-witness-" id="edit-add-second-witness-" name="add_second_witness_" class="form-select">
<option value="" selected="selected">- None -</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</fieldset>
</div>
</fieldset>
<fieldset class="js-webform-states-hidden js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3" data-drupal-selector="edit-witness-2"
data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022add_second_witness_\u0022]":{"value":"Yes"}}}" id="edit-witness-2" style="display: none;">
<legend>
<span class="fieldset-legend">WITNESS 2</span>
</legend>
<div class="fieldset-wrapper">
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-2-first-name- form-item-witness-2-first-name- mb-3">
<label for="edit-witness-2-first-name-">Witness 2 - First Name:</label>
<input class="col-md-6 js-webform-counter webform-counter form-control" data-counter-type="character" data-counter-minimum="1" data-counter-maximum="30"
data-counter-maximum-message="field can not be longer than 30 characters (this includes spaces)" minlength="1" data-drupal-selector="edit-witness-2-first-name-" type="text" id="edit-witness-2-first-name-" name="witness_2_first_name_"
value="" size="60" maxlength="30" data-drupal-states="{"required":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022add_second_witness_\u0022]":{"value":"Yes"}}}">
<div class="text-count-wrapper">
<div class="text-count-message" aria-live="assertive" aria-atomic="true" style="display: inline;">field can not be longer than 30 characters (this includes spaces)</div>
<div class="text-count-overflow-wrapper" style="display: none;"></div>
</div>
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-2-last-name- form-item-witness-2-last-name- mb-3">
<label for="edit-witness-2-last-name-">Witness 2 - Last Name:</label>
<input class="col-md-6 js-webform-counter webform-counter form-control" data-counter-type="character" data-counter-minimum="1" data-counter-maximum="30"
data-counter-maximum-message="field can not be longer than 30 characters (this includes spaces)" minlength="1" data-drupal-selector="edit-witness-2-last-name-" type="text" id="edit-witness-2-last-name-" name="witness_2_last_name_" value=""
size="60" maxlength="30" data-drupal-states="{"required":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022add_second_witness_\u0022]":{"value":"Yes"}}}">
<div class="text-count-wrapper">
<div class="text-count-message" aria-live="assertive" aria-atomic="true" style="display: inline;">field can not be longer than 30 characters (this includes spaces)</div>
<div class="text-count-overflow-wrapper" style="display: none;"></div>
</div>
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-2-address-1- form-item-witness-2-address-1- mb-3">
<label for="edit-witness-2-address-1-">Witness 2 - Address 1:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-witness-2-address-1-" type="text" id="edit-witness-2-address-1-" name="witness_2_address_1_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-2-address-2- form-item-witness-2-address-2- mb-3">
<label for="edit-witness-2-address-2-">Witness 2 - Address 2:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-witness-2-address-2-" type="text" id="edit-witness-2-address-2-" name="witness_2_address_2_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-2-city- form-item-witness-2-city- mb-3">
<label for="edit-witness-2-city-">Witness 2 - City:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-witness-2-city-" type="text" id="edit-witness-2-city-" name="witness_2_city_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="col-md-6 js-form-item js-form-type-select form-type-select js-form-item-witness-2-state- form-item-witness-2-state- mb-3">
<label for="edit-witness-2-state-">Witness 2 - State:</label>
<select data-drupal-selector="edit-witness-2-state-" id="edit-witness-2-state-" name="witness_2_state_" class="form-select">
<option value="" selected="selected">- None -</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select>
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-2-zip- form-item-witness-2-zip- mb-3">
<label for="edit-witness-2-zip-">Witness 2 - Zip:</label>
<input class="col-md-6 form-control" data-drupal-selector="edit-witness-2-zip-" type="text" id="edit-witness-2-zip-" name="witness_2_zip_" value="" size="60" maxlength="255">
</fieldset>
<fieldset class="col-md-6 js-form-item js-form-type-textfield form-type-textfield js-form-item-witness-2-phone- form-item-witness-2-phone- mb-3">
<label for="edit-witness-2-phone-">Witness 2 - Phone:</label>
<input data-drupal-selector="edit-witness-2-phone-" type="text" id="edit-witness-2-phone-" name="witness_2_phone_" value="" size="60" maxlength="255" class="form-control">
</fieldset>
</div>
</fieldset>
<fieldset data-drupal-selector="edit-covered-status" id="edit-covered-status" class="js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3">
<legend>
<span class="fieldset-legend">COVERED STATUS</span>
</legend>
<div class="fieldset-wrapper">
<div class="js-webform-states-hidden js-form-wrapper"
data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022complainant_self_identification\u0022]":{"value":"HUD Employee"}}}" style="display: none;">
<label data-drupal-selector="edit-i-for-hud-current-former-employees-" for="edit-i-for-hud-current-former-employees-">I. FOR HUD CURRENT/FORMER EMPLOYEES:</label></div>
<fieldset class="js-webform-states-hidden js-form-item js-form-type-textfield form-type-textfield js-form-item-state-your-position-at-hud- form-item-state-your-position-at-hud- mb-3" style="display: none;">
<label for="edit-state-your-position-at-hud-">State your position at HUD:</label>
<input data-drupal-selector="edit-state-your-position-at-hud-" type="text" id="edit-state-your-position-at-hud-" name="state_your_position_at_hud_" value="" size="60" maxlength="255" class="form-control"
data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022complainant_self_identification\u0022]":{"value":"HUD Employee"}}}">
</fieldset>
<fieldset class="js-webform-states-hidden js-form-item js-form-type-textfield form-type-textfield js-form-item-dates-of-employment-at-hud- form-item-dates-of-employment-at-hud- mb-3" style="display: none;">
<label for="edit-dates-of-employment-at-hud-">Dates of employment at HUD:</label>
<input data-drupal-selector="edit-dates-of-employment-at-hud-" type="text" id="edit-dates-of-employment-at-hud-" name="dates_of_employment_at_hud_" value="" size="60" maxlength="255" class="form-control"
data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022complainant_self_identification\u0022]":{"value":"HUD Employee"}}}">
</fieldset>
<div class="js-form-wrapper"
data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022complainant_self_identification\u0022]":{"!value":"HUD Employee"}}}"><label
data-drupal-selector="edit-ii-for-employees-of-hud-contractors-subcontractor-grantee-subgra" for="edit-ii-for-employees-of-hud-contractors-subcontractor-grantee-subgra">II. FOR EMPLOYEES OF HUD
CONTRACTORS/SUBCONTRACTOR/GRANTEE/SUBGRANTEE:</label></div>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-state-the-name-of-your-employer- form-item-state-the-name-of-your-employer- mb-3">
<label for="edit-state-the-name-of-your-employer-">State the name of your employer:</label>
<input data-drupal-selector="edit-state-the-name-of-your-employer-" type="text" id="edit-state-the-name-of-your-employer-" name="state_the_name_of_your_employer_" value="" size="60" maxlength="255" class="form-control"
data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022complainant_self_identification\u0022]":{"!value":"HUD Employee"}}}">
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-state-your-employer-s-relationship-with-hud-programs- form-item-state-your-employer-s-relationship-with-hud-programs- mb-3">
<label for="edit-state-your-employer-s-relationship-with-hud-programs-">State your employer's relationship with HUD programs:</label>
<input data-drupal-selector="edit-state-your-employer-s-relationship-with-hud-programs-" type="text" id="edit-state-your-employer-s-relationship-with-hud-programs-" name="state_your_employer_s_relationship_with_hud_programs_" value=""
size="60" maxlength="255" class="form-control"
data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022complainant_self_identification\u0022]":{"!value":"HUD Employee"}}}">
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-state-your-position-at-the-employer- form-item-state-your-position-at-the-employer- mb-3">
<label for="edit-state-your-position-at-the-employer-" class="js-form-required form-required">State your position at the employer:</label>
<input data-drupal-selector="edit-state-your-position-at-the-employer-" type="text" id="edit-state-your-position-at-the-employer-" name="state_your_position_at_the_employer_" value="" size="60" maxlength="255" class="form-control"
data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022complainant_self_identification\u0022]":{"!value":"HUD Employee"}},"required":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022complainant_self_identification\u0022]":{"!value":"HUD Employee"}}}"
required="required" aria-required="true">
</fieldset>
<fieldset class="js-form-item js-form-type-textfield form-type-textfield js-form-item-state-your-dates-of-employment-at-the-employer- form-item-state-your-dates-of-employment-at-the-employer- mb-3">
<label for="edit-state-your-dates-of-employment-at-the-employer-" class="js-form-required form-required">State your dates of employment at the employer:</label>
<input data-drupal-selector="edit-state-your-dates-of-employment-at-the-employer-" type="text" id="edit-state-your-dates-of-employment-at-the-employer-" name="state_your_dates_of_employment_at_the_employer_" value="" size="60" maxlength="255"
class="form-control"
data-drupal-states="{"visible":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022complainant_self_identification\u0022]":{"!value":"HUD Employee"}},"required":{".webform-submission-hotline-whistleblower-form-add-form :input[name=\u0022complainant_self_identification\u0022]":{"!value":"HUD Employee"}}}"
required="required" aria-required="true">
</fieldset>
</div>
</fieldset>
<fieldset data-drupal-selector="edit-disclosure" id="edit-disclosure" class="js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3">
<legend>
<span class="fieldset-legend">DISCLOSURE</span>
</legend>
<div class="fieldset-wrapper">
<fieldset class="js-form-item js-form-type-textarea form-type-textarea js-form-item-state-the-nature-of-the-violation-re-hud-programs-that-you-discl form-item-state-the-nature-of-the-violation-re-hud-programs-that-you-discl mb-3">
<label for="edit-state-the-nature-of-the-violation-re-hud-programs-that-you-discl" class="js-form-required form-required">State the nature of the violation regarding HUD programs that you disclosed:</label>
<div class="form-textarea-wrapper">
<textarea data-drupal-selector="edit-state-the-nature-of-the-violation-re-hud-programs-that-you-discl" id="edit-state-the-nature-of-the-violation-re-hud-programs-that-you-discl"
name="state_the_nature_of_the_violation_re_hud_programs_that_you_discl" rows="5" cols="60" class="form-textarea required form-control resize-vertical" required="required" aria-required="true"></textarea>
</div>
</fieldset>
<fieldset class="js-form-item js-form-type-textarea form-type-textarea js-form-item-how-become-aware form-item-how-become-aware mb-3">
<label for="edit-how-become-aware" class="js-form-required form-required">How did you become aware of the violation?</label>
<div class="form-textarea-wrapper">
<textarea data-drupal-selector="edit-how-become-aware" id="edit-how-become-aware" name="how_become_aware" rows="5" cols="60" class="form-textarea required form-control resize-vertical" required="required" aria-required="true"></textarea>
</div>
</fieldset>
<fieldset class="js-form-item js-form-type-textarea form-type-textarea js-form-item-provide-name-role form-item-provide-name-role mb-3">
<label for="edit-provide-name-role" class="js-form-required form-required">Provide the name and role (e.g. supervisor, HUD OIG) of the person to whom you made the disclosure, and the date of the disclosure:</label>
<div class="form-textarea-wrapper">
<textarea data-drupal-selector="edit-provide-name-role" id="edit-provide-name-role" name="provide_name_role" rows="5" cols="60" class="form-textarea required form-control resize-vertical" required="required" aria-required="true"></textarea>
</div>
</fieldset>
</div>
</fieldset>
<fieldset data-drupal-selector="edit-retaliaton" id="edit-retaliaton" class="js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3">
<legend>
<span class="fieldset-legend">RETALIATION</span>
</legend>
<div class="fieldset-wrapper">
<fieldset class="js-form-item js-form-type-textarea form-type-textarea js-form-item-what-and-when-occured form-item-what-and-when-occured mb-3">
<label for="edit-what-and-when-occured" class="js-form-required form-required">What adverse action occurred against you and when did it occur?</label>
<div class="form-textarea-wrapper">
<textarea data-drupal-selector="edit-what-and-when-occured" id="edit-what-and-when-occured" name="what_and_when_occured" rows="5" cols="60" class="form-textarea required form-control resize-vertical" required="required"
aria-required="true"></textarea>
</div>
</fieldset>
<fieldset class="js-form-item js-form-type-textarea form-type-textarea js-form-item-who-took-personnel form-item-who-took-personnel mb-3">
<label for="edit-who-took-personnel" class="js-form-required form-required">Who took the adverse action identified?</label>
<div class="form-textarea-wrapper">
<textarea data-drupal-selector="edit-who-took-personnel" id="edit-who-took-personnel" name="who_took_personnel" rows="5" cols="60" class="form-textarea required form-control resize-vertical" required="required"
aria-required="true"></textarea>
</div>
</fieldset>
<fieldset class="js-form-item js-form-type-textarea form-type-textarea js-form-item-relationship form-item-relationship mb-3">
<label for="edit-relationship" class="js-form-required form-required">What is the relationship of that person to you?</label>
<div class="form-textarea-wrapper">
<textarea data-drupal-selector="edit-relationship" id="edit-relationship" name="relationship" rows="5" cols="60" class="form-textarea required form-control resize-vertical" required="required" aria-required="true"></textarea>
</div>
</fieldset>
<fieldset class="js-form-item js-form-type-textarea form-type-textarea js-form-item-person-s-knowledge form-item-person-s-knowledge mb-3">
<label for="edit-person-s-knowledge" class="js-form-required form-required">What did the person who took the action know of your disclosure?</label>
<div class="form-textarea-wrapper">
<textarea data-drupal-selector="edit-person-s-knowledge" id="edit-person-s-knowledge" name="person_s_knowledge" rows="5" cols="60" class="form-textarea required form-control resize-vertical" required="required"
aria-required="true"></textarea>
</div>
</fieldset>
</div>
</fieldset>
<fieldset data-drupal-selector="edit-other-remedies" id="edit-other-remedies" class="js-webform-type-fieldset webform-type-fieldset js-form-item form-item js-form-wrapper form-wrapper mb-3">
<legend>
<span class="fieldset-legend">OTHER REMEDIES</span>
</legend>
<div class="fieldset-wrapper">
<fieldset class="js-form-item js-form-type-textarea form-type-textarea js-form-item-any-other-process form-item-any-other-process mb-3">
<label for="edit-any-other-process" class="js-form-required form-required">Have you grieved, appealed, or reported this retaliation through any other process (e.g., EEO, state lawsuit, etc.)? If so, please identify the other action:</label>
<div class="form-textarea-wrapper">
<textarea data-drupal-selector="edit-any-other-process" id="edit-any-other-process" name="any_other_process" rows="5" cols="60" class="form-textarea required form-control resize-vertical" required="required" aria-required="true"></textarea>
</div>
</fieldset>
<fieldset id="edit-thank-you" class="js-form-item js-form-type-item form-type-item js-form-item-thank-you form-item-thank-you form-no-label mb-3">
<label class="visually-hidden">Thank you</label>
<p><span><span><span><span><span><span>Thank you for your complaint, you will be contacted by HUD OIG who will treat your submission with confidentiality.</span></span></span></span></span></span></p>
</fieldset>
</div>
</fieldset>
<fieldset id="edit-processed-text" class="js-form-item js-form-type-processed-text form-type-processed-text js-form-item- form-item- form-no-label mb-3">
<div class="alert alert-danger"><strong class="red">If you are submitting a report of fraud, waste, abuse, and/or mismanagement to OIG Hotline and have additional documentation to support the allegation please retain the information but annotate
in the narrative that you have additional information. If it is determined that the additional information is needed, a HUD OIG employee will be in contact with you to facilitate the transfer of that information.</strong></div>
</fieldset>
<div data-drupal-selector="edit-actions" class="form-actions webform-actions js-form-wrapper form-wrapper mb-3" id="edit-actions"><button class="webform-button--submit button button--primary js-form-submit form-submit btn btn-primary"
data-drupal-selector="edit-actions-submit" type="submit" id="edit-actions-submit" name="op" value="SUBMIT FORM">SUBMIT FORM</button>
</div>
<input autocomplete="off" data-drupal-selector="form-5il7luebqw7ugleobwrvb1acowfvuimi1u-wne6ffc" type="hidden" name="form_build_id" value="form-5iL7lUebQw7ugLEObwRVB1aCoWFvUiMi1u__wNE6fFc" class="form-control">
<input data-drupal-selector="edit-webform-submission-hotline-whistleblower-form-add-form" type="hidden" name="form_id" value="webform_submission_hotline_whistleblower_form_add_form" class="form-control">
</form>Text Content
Skip to main content An official website of the United States government Here’s how you know The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Hotline Report Fraud, Waste and Abuse Office of Inspector General, Department of Housing and Urban Development * Library » * Audits & Evaluations * Other Publications * Investigation & Inquiry Reports * Recommendation Dashboard * Hearings & Correspondence * Top Management Challenges * Semiannual Reports * FOIA * Single Audit Guidance * Ongoing Work * Combating Fraud » * What You Can Do * Notices & Alerts * Common Fraud Schemes * Whistleblower Rights * News & Congressional » * Press Releases * Media Material * Congressional Affairs * About HUD OIG » * The Inspector General * Organization & Staff * Mission & Vision * Strategy & Performance * What We Do * Careers * Contacts & Locations EnglishEspañol Search WHISTLEBLOWER RETALIATION COMPLAINT FORM 1. Home 2. Whistleblower Retaliation Complaint Form COMPLAINANT INFORMATION You are a: - Select -HUD EmployeeHUD OIG EmployeeHUD ContractorProgram ParticipantConcerned Citizen Your First Name: field can not be longer than 30 characters (this includes spaces) Your Last Name: field can not be longer than 30 characters (this includes spaces) Your Address 1: Your Address 2: Your City: Your State: - None -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming- None - Your Zip: Your Phone: Your Email: Your Date of Birth: Preferred Method of Contact - None -AddressEmail AddressPhone Number WHEN DID THIS OCCUR? Specific Date? - None -YesNo Date: Date Range: 10000 character(s) remaining Add a witness? - None -YesNo WITNESS 1 Witness 1 - First Name: field can not be longer than 30 characters (this includes spaces) Witness 1 - Last Name: field can not be longer than 30 characters (this includes spaces) Witness 1 - Address 1: Witness 1 - Address 2: Witness 1 - City: Witness 1 - State: - None -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Witness 1 - Zip: Witness 1 - Phone: Add another witness? - None -YesNo WITNESS 2 Witness 2 - First Name: field can not be longer than 30 characters (this includes spaces) Witness 2 - Last Name: field can not be longer than 30 characters (this includes spaces) Witness 2 - Address 1: Witness 2 - Address 2: Witness 2 - City: Witness 2 - State: - None -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Witness 2 - Zip: Witness 2 - Phone: COVERED STATUS I. FOR HUD CURRENT/FORMER EMPLOYEES: State your position at HUD: Dates of employment at HUD: II. FOR EMPLOYEES OF HUD CONTRACTORS/SUBCONTRACTOR/GRANTEE/SUBGRANTEE: State the name of your employer: State your employer's relationship with HUD programs: State your position at the employer: State your dates of employment at the employer: DISCLOSURE State the nature of the violation regarding HUD programs that you disclosed: How did you become aware of the violation? Provide the name and role (e.g. supervisor, HUD OIG) of the person to whom you made the disclosure, and the date of the disclosure: RETALIATION What adverse action occurred against you and when did it occur? Who took the adverse action identified? What is the relationship of that person to you? What did the person who took the action know of your disclosure? OTHER REMEDIES Have you grieved, appealed, or reported this retaliation through any other process (e.g., EEO, state lawsuit, etc.)? If so, please identify the other action: Thank you Thank you for your complaint, you will be contacted by HUD OIG who will treat your submission with confidentiality. If you are submitting a report of fraud, waste, abuse, and/or mismanagement to OIG Hotline and have additional documentation to support the allegation please retain the information but annotate in the narrative that you have additional information. If it is determined that the additional information is needed, a HUD OIG employee will be in contact with you to facilitate the transfer of that information. 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