The following forms are provided to assist a covered employee in pursuing a claim of a violation of sections 201 through 207 of the Congressional Accountability Act (CAA) under the Office of Congressional Workplace Rights' Administrative Dispute Resolution (ADR) process. These have been updated to reflect the changes of the CAA Reform Act effective June 19, 2019. (Learn more about the revised ADR process.)

Once these forms are completed, please print, sign, scan and e-mail the completed form to

Claim Form

Amended Claim Form

Request for Mediation

Notice of Designation of Representative

Filing and Submission:

This form must be filed with the OCWR prior to the expiration of the 180-day period which begins on the date of the alleged violation of the CAA. The OCWR will not accept a Claim Form after the applicable deadline. Filing this form initiates formal proceedings on your claim(s) alleging that the CAA has been violated. Please be advised that immediately after you submit your claim form, a copy will be provided to your employing office.

All claim forms must be either e-filed (, emailed (, faxed (202-426-1913), or hand-delivered to: John Adams Building, 110 Second Street, SE, Room LA-200, Washington, DC 20540-1999.


Please note: The OCWR now provides employees, at no cost, the services of a Confidential Advisor. Employees may meet with the Confidential Advisor to discuss their workplace concerns, and the Advisor will inform them of their rights and options under the CAA.  The Confidential Advisor also may help an employee draft a claim, but may not represent the employee in any proceeding.