Impasse Services Request Form

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

advancing workplace rights, safety and health, and accessibility in the legislative branch

Office of Congressional Workplace Rights

Room LA-200, John Adams Building · 110 Second Street, SE · Washington, DC 20540-1999 · t/202.724.9250 · f/202.426.1913

www.ocwr.gov

1

LABOR MANAGEMENT – IMPASSE SERVICES REQUEST

See instructions below. Attach additional sheets if needed, numbered according to the

box(es) below to which they pertain.

DO NOT WRITE IN THIS SPACE

Case No.

IMPASSE FORM Date Filed

1. This form, along with the attached information specified below, is a request to the OCWR Board of Directors filed under Section 220 o f the

Congressional Accountability Act and the OCWR’s regulations to:

___ A. Consider a negotiation impasse

___ B. Approve a joint request for a binding arbitration procedure to resolve a negotiation impasse

2. Employing office information:

Name: Address:

Name of person authorized to act on behalf of the employing office:

Name:

Title: E-mail:

Tel. #: Fax #:

3. Labor organization information:

Name: Address:

Name of person authorized to act on behalf of the labor organization:

Name:

Title: E-mail:

Tel. #: Fax #:

4. Description of bargaining unit:

Number of employees in bargaining unit:

5.Date labor agreement expires: