U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

If you file an FLSA claim with OPM, you must file the claim in writing, and you or your representative must sign your claim. You may not file an FLSA claim electronically. You may submit relevant information to OPM at any time before we make a decision on your claim. Your claim must include the following:

1. Your full name (this highlighted link will take you to a note about requesting confidentiality); the agency employing you during the claim period; the position (job title, pay plan, series, and grade) you occupied during the claim period; your current mailing address, commercial telephone number, and facsimile machine number, if available; and if you have designated one, your representative's mailing address, commercial telephone number, and facsimile machine number, if available;
    

2. A description of the nature of your claim and the specific issues or incidents giving rise to your claim, including the time period covered by your claim;
    

3. A description of actions you took to resolve your claim within the agency and the results of any actions taken;
    

4. A copy of any relevant decision or written response by the agency;
    

5. Evidence available to you or your representative which supports your claim, including the identity, commercial telephone number, and location of other individuals who may be able to provide information relating to your claim;
    

6. The remedy you seek;
    

7. Evidence, if available, that the claim period was preserved in accordance with the time limits in 5 CFR 551.702 (see the claims fact sheet). The date the agency or OPM received your claim, whichever is earlier, becomes the date the claim period is preserved;
    

8. A statement that you were or were not a member of a collective bargaining unit at any time during the claim period;
    

9. If you were a member of a bargaining unit, a statement that you were or were not covered by a negotiated grievance procedure at any time during the claim period, and if covered, whether that procedure specifically excluded your claim from the scope of the negotiated grievance procedure;
    

10. A statement that you have or have not filed an action in an appropriate United States court; and
     

11. Any other information you believe OPM should consider. 

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