UNITED STATES OF AMERICA 

FEDERAL LABOR RELATIONS AUTHORITY 

CHARGE AGAINST AN AGENCY

FOR FLRA USE ONLY

Case No.

Date Filed

1. AGENCY AGAINST WHICH CHARGE IS BROUGHT 2. CHARGING PARTY 

a. Name of Charged Agency  (include address, city, state, & ZIP) a. Name of Charging Party  (include address, city, state, & ZIP)

b. Agency Representative  (include name, title, address) b. Charging Party Representative  (include name, title, address)

tel. fax tel. fax

e‐mail e‐mail

3. BASIS OF THE CHARGE 

a. Set forth a clear and concise statement of the facts constituting the alleged unfair labor practice, including date and location of the particular acts.

b. Which subsection(s) of 5 U.S.C. 7116(a) do you believe the Agency has violated?           (1)      (2)     (3)     (4)     (5)     (6)     (7)     (8) 

c.      Have you or anyone else raised this matter in any other procedure?                 No         Yes        If yes, where?

 Grievance Procedure               

 Equal Employment Opportunity Commission

 Other Administrative or Judicial Proceeding     

 Federal Mediation and Conciliation Service  

 Merit Systems Protection Board            

 Negotiability Appeal to FLRA                    

 Federal Service Impasses Panel

 Office of Special Counsel

 Other _____________________________

4. DECLARATION 

I DECLARE THAT I HAVE READ THIS CHARGE AND THAT THE STATEMENTS IN IT ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

I UNDERSTAND THAT MAKING WILLFULLY FALSE STATEMENTS CAN BE PUNISHED BY FINE AND IMPRISONMENT, 18 U.S.C. 1001.  

THIS CHARGE WAS SERVED ON THE PERSON IDENTIFIED IN BOX 1b BY [check all appropriate boxes]

  In Person                   1st Class Mail                Fax                Commercial Delivery             Certified Mail            e‐mail (see reverse)

Type or Print Your Name Your Signature Date

Form Exempt Under 44 U.S.C. 3512 FLRA Form 22 (Rev. 10/2014)
INSTRUCTIONS FOR COMPLETING FORM 22: 

General 

Use this form if you are charging that a federal agency committed an unfair labor practice under paragraph (a) of section 7116 of the 

Federal Service Labor-Management Relations Statute. File an original form with the appropriate Regional Director, Federal Labor

Relations Authority. If you do not know that address, go to the FLRA’s website at www.flra.gov or contact the Office of the General 

Counsel, Federal Labor Relations Authority, (202) 218-7910. If filing the charge by fax, you need only file a fax-transmitted copy of the 

charge (with required signature) with the Region. You assume responsibility for receipt of a charge. A charge is a self-contained 

document without a need to refer to supporting evidence and documents that are also submitted to the Regional Director along with 

the charge. If filing a charge by fax, do not submit supporting evidence and documents by fax. See 5 C.F.R. Part 2423 for an 

explanation of unfair labor practice proceedings and, in particular, §§ 2423.4 and 2423.6, which concern the contents, filing, and 

service of the charge and supporting evidence and documents. 

Instructions for filling out each numbered box 

#1a. Give the full name of the agency, and component if applicable, you are charging and the mailing address, including the street 

number, city, state, zip code. If you are charging more than one agency or component with the same act, file a separate charge for 

each agency or component. 

#1b. Give the full name, title, and other contact information for the agency’s representative. Be as specific and as accurate as possible. 

#2a. Give the full name of the union or individual filing the charge and the mailing address, including the street number, city, state, zip 

code. If the union is affiliated with a national organization, give both the national affiliation and local designation. 

#2b. Give the full name, title, and other contact information for you or your representative. Providing all available contact information, 

especially e-mail addresses, will assist the investigation of your charge. 

#3a. It is important that the basis for the charge be brief and factual, rather than opinion. Describe what happened that constitutes an 

unfair labor practice, who did it, where it occurred and when. 

-Give dates and times of significant events as accurately as possible. 

-Give specific locations when important, e.g., "The meeting was held in the auditorium of Building 36." 

-Identify who was involved by title, e.g., "Chief Steward Pat Jones" or "Lou Smith, the File Room Supervisor." 

-Tell what happened, in chronological order. 

#3b. Identify which one or more of the following subsections of 5 U.S.C. 7116(a) has or have allegedly been violated. Subsection 

(1) has already been selected for you because a violation of (2) through (8) is an automatic violation of (1). List all sections 

allegedly violated: 

7116(a) For the purpose of this chapter, it shall be an unfair labor practice for an agency- 

(1) to interfere with, restrain, or coerce any employee in the exercise by the employee of any right under this chapter; 

(2) to encourage or discourage membership in any labor organization by discrimination in connection with hiring, tenure, 

promotion, or other conditions of employment; 

(3) to sponsor, control, or otherwise assist any labor organization, other than to furnish, upon request, customary and routine

services and facilities if the services and facilities are also furnished on an impartial basis to other labor organizations having 

equivalent status; 

(4) to discipline or otherwise discriminate against an employee because the employee has filed a complaint, affidavit, or 

petition, or has given any information or testimony under this chapter; 

(5) to refuse to consult or negotiate in good faith with a labor organization as required by this chapter; 

(6) to fail or refuse to cooperate in impasse procedures and impasse decisions as required by this chapter; 

(7) to enforce any rule or regulation (other than a rule or regulation implementing section 2302 of this title) which is in conflict 

with any applicable collective bargaining agreement if the agreement was in effect before the date the rule or regulation was 

prescribed; or 

(8) to otherwise fail or refuse to comply with any provision of this chapter. 

#3c. If you or anyone else that you know of has raised this same matter in another forum, check the appropriate box or boxes. 

#4. Type or print your name. Then sign and date the charge attesting to the truth of the charge and that you have served the charged 

party (individual named in box #1b). Check the box or boxes for all the methods by which you served the charge. You may serve the 

charge by e-mail only if the Charged Party has agreed to be served by e-mail.