FEDERAL SERVICE IMPASSES PANEL 

REQUEST FOR ASSISTANCE 

INSTRUCTION: File an original and one copy of this 

request (including attachments) with the Executive 

Director, Federal Service Impasses Panel, 1400 K Street, 

NW, Washington, DC 20424-0001. Also serve a copy of 

the request (with attachments) on the other party to the 

dispute and on the mediator, and submit a written 

statement of such service to the Executive Director. 

Telephone number (202) 218-7790; Fax Number (202) 

482-6674. 

Form Approved: 

OMB No. 3070-0007 

Date: 

1. This is a request to the Panel, filed under title 5 of U.S. Code and the Panel’s regulations to: 

(Check One) 

(a) □ Consider a negotiation impasse. 

(b) □ Approve a joint request for a binding arbitration procedure to resolve a negotiation impasse. 

 

(c) □ Consider an impasse resulting from an agency determination not to establish or terminate a 

compressed work schedule under the Federal Employees Flexible and Compressed Work 

Schedules Act. 

2. (a) Name of Agency 

(b) Address 

 (c) Person to Contact Title 

 (d) Phone No. 

(e) Fax No. 

3. (a) Name of Labor Organization 

 (b) Address 

 (c) Person to Contact Title 

 (d) Phone No. 

 (e) Fax No. 

4. Description of Bargaining Unit 

 

 

5. Number of Employees in Bargaining Unit Date Labor Agreement Expires 

6. (a) If term 1(a) is checked, attach information containing (1) the issues at impasse and requesting 

party’s summary position thereon; (2) the number, length, and dates of negotiation and mediation 

sessions held; (3) the name and address of the mediator; and (4) the FMCS case number, if 

known. 
(b) If item 1(b) is checked, attach information containing (1) the issues at impasse; (2) the number, 

length, and dates of negotiation and mediation sessions held; (3) the name and address of the 

mediator; (4) the FMCS case number; (5) the issues to be submitted to the arbitrator; (6) a 

statement as to whether any of the proposals to be submitted to the arbitrator contain questions 

concerning the duty to bargain and a statement of each party’s position concerning such 

questions; and (7) the arbitration procedures to be used. 

(c) If item 1(c) is checked, attach information containing (1) the number, length, and dates of 

negotiation sessions held; (2) the schedule or proposed schedule which is the subject of the 

agency’s determination; (3) the agency’s written determination and the finding on which the 

determination is based, including, in a case where the finding is made by a duly authorized 

delegatee, evidence of a specific delegation of authority to make such a finding; (4) a copy of any 

collective bargaining agreement between the parties and any other agreements concerning 

alternative work schedules; and (5) a summary of the position of the initiating party with a 

respect to the agency’s determination. 

7. (a) Name of Individual Filing this Request 

 Title 

 (b) Address 

 (c) Signature 

 (d) Phone No. 

 (e) Fax No. 

8. If this is a joint labor-management request. 

 (a) Name of Other Individual Filing This Request 

 Title 

 (b) Address 

 (c) Signature 

 (d) Phone No. 

 (e) Fax No. 

FLRA Form 14 

Public reporting burden for this collection of information is estimated to average 1⁄2 hours per response, 

including the time for reviewing instructions, searching existing data sources, gathering and maintaining data 

needed and completing and reviewing the collection of information. Send comments regarding this burden 

estimate or any other aspect of this collection of information including sessions for reducing the burden to 

Federal Service Impasses Panel, 1400 K Street, NW, Washington, DC 20424-0001; and to the Office of 

Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20523. This form 

is not valid unless an OMB control number is displayed on the form.