This form is authorized by 8 U.S.C. 1182(n)(2)(G)(ii) of the American Competitiveness and Workforce Improvement Act of 1998. The information provided on this form will assist the Department of Labor in determining whether the named employer of H-1B nonimmigrants has committed a violation of provisions of the H-1B program. A person can fill out this form to report alleged H-1B violations by an employer. The form must be forwarded to the Wage and Hour Division (WHD) office which has jurisdiction over the physical location of the employer. For WHD locations, see the telephone directories under U.S. Government, Department of Labor, Wage and Hour Division or http://www.dol.gov/contacts/whd/america2 on the internet.
Please provide as much of the requested information as possible. Attach additional sheets if you need additional space to respond to a question. If you do not understand a term, or need assistance in the completion of this form, please contact the local Wage and Hour office of the U.S. Department of Labor. After you submit the form, a representative from the Department of Labor may contact you if further information is necessary to initiate an investigation.
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