Appendix B to Part 165 - Form TCR and Form WP-APP
17:2.0.1.1.28.0.1.21.26 : Appendix B
Appendix B to Part 165 - Form TCR and Form WP-APP
Submission
Procedures
Questions concerning this form may be directed to Commodity
Futures Trading Commission, Whistleblower Office, Three Lafayette
Centre, 1155 21st Street NW., Washington, DC 20581.
• If you are submitting information for the CFTC's whistleblower
award program, you must submit your information using this
Form TCR.
• You may submit this form electronically, through the Web
portal found on the CFTC's Web site at
http://www.whistleblower.gov. You may also print this form
and submit it by mail to Commodity Futures Trading Commission,
Whistleblower Office, Three Lafayette Centre, 1155 21st Street,
NW., Washington, DC 20581, or by facsimile to (202) 418-5975.
• You have the right to submit information anonymously. If you
do not submit anonymously, please note that the CFTC is required by
law to maintain the confidentiality of any information which could
reasonably identify you, and will only reveal such information in
limited and specifically-defined circumstances. See 7 U.S.C.
26(h)(2); 17 CFR 165.4. However, in order to receive a
whistleblower award, you will need to be identified to select CFTC
staff for a final eligibility determination, and in unusual
circumstances, you may need to be identified publicly for trial.
You should therefore provide some means for the CFTC's staff to
contact you, such as a telephone number or an email address.
Instructions for Completing Form TCR General
All references to “you” and “your” are intended to mean the
complainant.
Section A: Tell Us About Yourself
Questions 1-14: Please provide the following information about
yourself:
☐ last name, first name and middle initial; ☐ complete address,
including city, state and zip code; ☐ telephone number and, if
available, an alternate number where you can be reached; ☐ your
email address (to facilitate communications, we strongly encourage
you to provide an email address, especially if you are filing
anonymously); ☐ your preferred method of communication; and ☐ your
occupation.