Amended Claim Form

• Legal Form Number: 4.08(d)
• Section: Office of Congressional Workplace Rights (United States)

Office of Congressional Workplace Rights

John Adams Building, 110 Second Street, SE, Room LA-200 | Washington, DC 20540 -1999

(202) 724-9250 (O) | (202) 426-1913 (F)

ocwr.gov

OCWR ADR Amended Claim Form 4.08(d) 10/2022

Office of Congressional Workplace Rights

Administrative Dispute Resolution Amended Claim Form

Instructions

You ma y use th is form to amend yo ur initi al (origi nal ) admin ist rat iv e dis put e r eso lutio n

(ADR) claim. Y ou are a llo wed to f ile on ly one amen ded cl aim form as a matter o f r igh t,

wit hin 15 c ale nda r days aft er y ou f ile d yo ur ori gin al c lai m fo rm p urs uant t o

sectio n 4.08 (d) of the Offi ce of Con gre ssi ona l Work pla ce Rights (OCWR) Proce dur al

Rul es.

You hav e th e ri ght to cons ult wit h an OCW R Co nfi den tia l Ad visor to di scuss your

concer ns pri or to subm itting an amen ded claim . The Con fid ent ial Advis or is an

exp eri enc ed emplo yme nt law attorney w ith b road kn owl edg e of the la ws a ppl ied b y the

Con gre ssi ona l Accoun tability A ct (CAA ), and the OCW R’s ADR p rocedu res to resol ve

claims . If yo u a re n ot rep res ented by an a tto rney, the Co nfi den tia l A dvi sor al so may hel p

you draft a cl aim. T he Con fid ent ial Ad vis or may not re pre sen t a ny pa rt y in a p roc eed ing.

The ser vic es of th e Co nfi den tia l Advis or are provide d on a pri vileg ed and confi den tia l

bas is.

If you wo uld lik e to req ues t the ass istan ce of the Confid ent ial Adv iso r, p lea se c ont act

the OC WR at (20 2) 724-9 250 or send an e- mail t o Con fid ent ial Advis or@ocw r.g ov

Cas e n umb er:

The OCW R sh oul d have ass ign ed a cas e nu mb er f or y ou a fte r yo u file d yo ur i nit ial cla im.

You m ust p rov ide t hat cas e num ber o n thi s amende d cla im form. If no case num ber h as

been ass ign ed to your clai m, pleas e contact the O CWR at (202) 7 24 -9250 o r sen d an e -

mai l t o O CWR efile@oc wr. gov .

Filing an d S ub miss io n:

As stated above, you must fi le your amend ed claim form wi th th e OCW R no late r tha n

15 c ale nda r days after th e da te you fil ed you r i nit ial cl aim fo rm. Pl eas e be ad vis ed tha t