Contractor Reporting Form

The Pension Benefit Guaranty Corporation (PBGC) Office of Inspector General (OIG) provides contractors with this form to assist with compliance with the December 12, 2008, FAR Amendment, 73 Federal Regulation 67064, which requires contractors to report credible evidence of violations of the civil False Claims Act or certain violations of criminal law which have occurred in connection with a government contract.

Individuals who complete this form must be an officer, manager or authorized representative within the company for whom this report is being made, and thereby empowered to speak for the company. If the information you wish to provide does not fall within these guidelines, please access the OIG HOTLINE at 1-800-303-9737.

To use this form, download and print a copy, complete and sign this form, save a copy of this form, and submit the form to PBGC OIG by fax or mail. The OIG may contact you for additional information or materials, if necessary.