Request for Mediation Form

• Legal Form Number: 404
• Section: Office of Congressional Workplace Rights (United States)

03/2020

Office of Congressional Workplace Rights

Request for Mediation

OCWR Form 404

OCWR Case no.: __________________________

Mediation is a process provided by the Office of Congressional Workplace Rights

(OCWR) for the parties involved in a claim to explore possible alternatives to litigation.

Mediation is voluntary, may be initiated by either party, and may only proceed if both

parties agree to mediate. The time to request mediation begins after a claim is filed and

ends on the date on which a merits hearing officer issues a written decision on the claim,

or until the claimant files a complaint to initiate a civil action in Federal court. For more

information on mediation under the Congressional Accountability Act of 1995, as

amended by the Congressional Accountability Act of 1995 Reform Act of 2018,

see 2 U.S.C. § 1403 and OCWR Procedural Rule § 4.07.

To request mediation in the above-referenced matter, please provide your information

below and return this completed form to the OCWR via email (OCWRefile@ocwr.gov),

fax (202-426-1913), mail or hand-delivery to the Library of Congress, John Adams

Building, 110 Second Street, SE, Room LA-200, Washington, DC 20540.

Name: ___________________________________________________________________

Please check one: □Claimant □ Respondent

Preferred phone no.:________________________________________________________

Secondary phone no.: ______________________________________________________

Mailing address (mail will be delayed due to anthrax screening): ___________________

_________________________________________________________________________

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Office of Congressional Workplace Rights

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

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

www.ocwr.gov