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 may use this form to amend your initial (original) administrative dispute resolution

(ADR) claim. You are allowed to file only one amended claim form as a matter of right,

within15 calendar daysafter you filed youroriginal claim form pursuant to

section 4.08(d)of the Office of Congressional Workplace Rights (OCWR)Procedural

Rules.

Youhave the rightto consultwith anOCWR Confidential Advisorto discussyour

concerns prior to submitting an amendedclaim. The ConfidentialAdvisor is an

experienced employment law attorney with broad knowledge of the laws applied by the

Congressional Accountability Act (CAA), and the OCWR’sADR proceduresto resolve

claims. If you are not represented by an attorney, the Confidential Advisor also may help

you draft a claim. The Confidential Advisor may not represent any party in a proceeding.

Theservices of the Confidential Advisor are provided on aprivileged and confidential

basis.

If you would like to request the assistance ofthe Confidential Advisor, please contact

the OCWR at (202) 724-9250 or send an e-mail to ConfidentialAdvisor@ocwr.gov

Case number:

The OCWR should have assigned a case number for you after you filed your initial claim.

You must provide that case number on this amended claim form.If no case number has

been assigned to your claim, please contact the OCWR at (202) 724-9250 or send an e-

mail to OCWRefile@ocwr.gov.

Filing and Submission:

As stated above, you must file your amended claim form with the OCWR no later than

15 calendar days after the date you filed your initial claim form.Please be advised that