VA Form 10177, WHISTLEBLOWER COMPLAINT FORM. 10177, WHISTLEBLOWER, COMPLAINT 2025

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The document is an OPTIONAL EMPLOYEE DISCLOSURE FORM from the Department of Veterans Affairs, designed for employees to report potential violations, mismanagement, waste of funds, abuse of authority, or dangers to public health or safety. It outlines the process for submitting disclosures to the Office of Accountability and Whistleblower Protection (OAWP), including definitions of key terms, protections against retaliation, and instructions for filing a disclosure. Employees can submit their disclosures anonymously and are encouraged to provide detailed information to facilitate effective review.

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Click ‘Get Form’ to open VA Form 10177 in the editor.
Begin with Part 1: Personal Information. Fill in your name, address, and contact details. If any field is not applicable, enter 'N/A' or 'Unknown'.
Proceed to Part 2: Employer Information. Provide the name and address of the VA facility where the disclosed activity occurred.
In Part 3: Details of Your Disclosure, indicate how you know about the information being disclosed by checking relevant boxes and providing specific details about the wrongdoing.
Describe the agency wrongdoing in detail, including dates and identities of involved persons. Attach any supporting documents if necessary.
Finally, complete Part 4: Consent, Signature and Submission. Choose whether you consent to release your identity, sign the form, and include any attachments before submitting.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (126 Votes)
2018	4.4 Satisfied (57 Votes)
2017	4.3 Satisfied (58 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What qualifies as a whistleblower complaint?

Whistleblowing means disclosing information that you reasonably believe is evidence of a violation of any law, rule, or regulation; gross mismanagement; a gross waste of funds; an abuse of authority; or a substantial and specific danger to public health or safety.

How to file a VA whistleblower complaint?

Q: How can I make a whistleblower disclosure, report whistleblower retaliation, or report VA senior leader misconduct or poor performance to OAWP? A: Please complete our Complaint and Disclosure Form or call us toll-free at 1-855-429-6669. Anonymous or confidential submissions may be made using either option.

What proof do you need as a whistleblower?

The Complainant and the Respondent should keep any potential evidence regarding the circumstances of the allegations, including all pertinent emails, letters, notes, text messages, voicemails, phone logs, personnel files, contracts, work products, and meeting minutes.

What is a VA whistleblower?

The Whistleblower Navigator (WBN) provides support to whistleblowers by providing information about the Office of Accountability and Whistleblower Protection (OAWP) processes, procedures, and practices. Whistleblowers are VA employees or applicants for VA employment who make a whistleblower disclosure.