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 definition of disclosures, protections against retaliation, and instructions for submitting a disclosure either through this form or other avenues. The form includes sections for personal information, details of the alleged wrongdoing, and consent regarding identity disclosure.

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Click ‘Get Form’ to open the 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 details about the VA facility where the disclosed activity occurred.
In Part 3: Details of Your Disclosure, indicate how you know about the information being disclosed. Check all relevant boxes and provide specific details about the wrongdoing.
Complete Part 4: Consent, Signature and Submission by selecting whether you consent to the release of your identity and signing the form.
Attach any supporting documents that may strengthen your disclosure before submitting it through our platform.

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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.

Do most whistleblower cases go to trial?

The time periods vary from 30 days to 180 days, depending on the specific law (statute) that applies. For example, Section 11(c) of the OSH Act, which covers workplace safety and health matters, requires that a complaint be filed within 30 days of the adverse employment actionadverse employment action.

What are the forms of whistleblower retaliation?

consider what evidence might be available to support the concern. reassure the whistleblower that you will keep their identity confidential. reassure the whistleblower they will not suffer any detriment for raising concerns. try and answer any questions the whistleblower has and explain why you cannot answer them if

What happens when you file a whistleblower complaint?

Intimidation or harassment. Making threats. Reassignment to a less desirable position or actions affecting prospects for promotion (such as excluding an employee from training meetings) Reducing or changing pay or hours.

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?

In fact, roughly 90% of the False Claims Act cases in which the government intervenes resolve favorably by settlement or trial, resulting in vindication for the whistleblower and a portion of the governments recovery.

va whistleblower hotline

VA whistleblower settlement VA Accountability and Whistleblower Protection Act of 2017 List of VA employees fired VA Accountability Act Who signed the VA Accountability Act VA Accountability Act 2017 Restore VA Accountability Act Principle of disclosure VA

What are the consequences of whistleblowing?

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.