FCA Claim Form

• Legal Form Number: Fair Chance Act (FCA)
• Section: Office of Congressional Workplace Rights (United States)

The Fair Chance to Compete for Jobs

Act (FCA) Claim Form

Office of Co ngre ssional Workplace Rights

Instructions

This for m may be use d by applicants for employme nt vac ancies with e mploying offices

in the legisla tive bra nch to file a c laim with the Office of Congressional Workplac e Rights

(OCWR) alleging violations(s) of the Fair Chance to C ompete for Jobs A ct (FCA ), which

is codified a t Sect ion 207 of the Congre ssional Acc ounta bility Act (C AA), 2 U.S.C.

§ 1316b. The FCA prohibits employing of fices from requesting that applicants for most

jobs disclose information on their arrest and convic tion history before a conditional job

offer is made.

IM POR TANT NO TICES

This form may only be use d for FCA claims . Us e of anindividual’scriminalhistoryin

making e mployment decisions may, in some instances , violate the anti-discrimination

provisions of the CAA (whether or not it also violates the FCA). If you claim that an

employing office discriminated against you in its reques t for or use of criminal history

information, you must submit that discrimination claim on the form available on

the OCWR's File A Claim web page. For assistance, please contact the OCWR at (202)

724-9250.

You have the right to re ceive ass istance fro m an OC WR Confide ntial Advis or.

If you have que stions or concer ns about how to complete this C laim For m, the

Administra tive Dis pute Re solution (A DR) proc ess of the O CWR, or the specif ic

employme nt laws a pplicable to your w orkpla ce, and you do not ha ve a designat ed attorney

re pres entative , you have the r ight t o consult with an OCWR Confident ial Advisor, a t no

cost to you. The C onfidentia l Advisor ca n inform you about your rights unde r the FCA,

the CAA , a nd the OCWR’s proc edur es, disc uss your conc erns , and cons ult with you

re garding your c laims and t he options a vailable to you unde r the FCA a nd CA A for

re solving them. The Confidential A dvisor will provide thes e servic es to you on a

privilege d and c onfide ntial basis .

Office of Congressional WorkplaceRig hts

110 SecondStreet, SE, RoomLA-200 | Washington, DC 20540-1999

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

www.ocwr.gov

OCWR FCA Claim Form 12/2021