UNITED STATES OF AMERICA 

FEDERAL LABOR RELATIONS AUTHORITY 

CHARGE AGAINST A LABOR ORGANIZATION

FOR FLRA USE ONLY

Case No.

Date Filed

1. CHARGED LABOR ORGANIZATION 2. CHARGING PARTY

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

b. Charged Labor Organization 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(b) and/or (c) do you believe the Labor Organization has violated?

716(b)(1)      (b)(2)      (b)(3)      (b)(4)      (b)(5)      (b)(6)      (b)(7)      (b)(8)  7116(c)(1)    (c)(2) 

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 23 (Rev. 10/2014)
INSTRUCTIONS FOR COMPLETING FORM 23: 

General 

Use this form if you are charging that a labor organization or its agents committed an unfair labor practice under paragraph (b) and/or 

(c) 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, 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 CFR 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 labor organization (including the name of the local and number and its national or international 

affiliation, if any) you are charging and the mailing address, including the street number, city, state, zip code. If you are charging 

more than one labor organization with the same act, file a separate charge for each labor organization. 

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

possible. 

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

List all sections allegedly violated: 

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

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

(2) to cause or attempt to cause an agency to discriminate against any employee in the exercise by the employee of any right 

under this chapter; 

(3) to coerce, discipline, fine, or attempt to coerce a member of the labor organization as punishment, reprisal, or for the purpose 

of hindering or impeding the member's work performance or productivity as an employee or the discharge of the member's duties 

as an employee; 

(4) to discriminate against an employee with regard to the terms or conditions of membership in the labor organization on the 

basis of race, color, creed, national origin, sex, age, preferential or nonpreferential civil service status, political affiliation, marital 

status, or handicapping condition; 

(5) to refuse to consult or negotiate in good faith with an agency as required by this chapter; 

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

(7) (A) to call, or participate in, a strike, work stoppage, or slowdown, or picketing of an agency in a labor-management dispute if 

such picketing interferes with an agency's operations, or 

(B) to condone any activity described in subparagraph (A) of this paragraph by failing to take action to prevent or stop such 

activity; or 

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

7116(c) For the purpose of this chapter it shall be an unfair labor practice for an exclusive representative to deny membership to any 

employee in the appropriate unit represented by such exclusive representative except for failure- 

(1) to meet reasonable occupational standards uniformly required for admission, or 

(2) to tender dues uniformly required as a condition of acquiring and retaining membership. This subsection does not preclude any 

labor organization from enforcing discipline in accordance with procedures under its constitution or by laws to the extent 

consistent with the provisions of this chapter. 

#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. 

#2a. Give the full name of the Charging Party and the mailing address, including the street number, city, state, zip code. If a union, and 

affiliated with a national organization, give both the national affiliation and local designation. If an agency, give the name of the agency 

and, if applicable, component. 

#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. 

#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.