USE THIS FORM ONLY IF THE UNION IS SEEKING REVIEW OF A PROVISION AGREED TO BY THE UNION AND AGENCY REPRESENTATIVE, THAT HAS BEEN DISAPPROVED BY THE AGENCY HEAD ON REVIEW PURSUANT TO 5 U.S.C. § 7114(C).

Important Information:  This form is to be used to initiate a negotiability proceeding and provide the Agency with notice that the Union requests a decision from the Authority that a specific provision is legal.  Section 2424.22 of the Authority's Regulations requires the Union in the petition for review to, among other things, set out the exact language at issue, explain the meaning of the language, explain how it is intended to operate, explain technical or unusual terms, and provide copies of materials that support the Union's position.

The information requested below may be provided on this form or in a separately created document.  If you have questions about completing this form, please contact the Authority’s Office of Case Intake and Publication at (202) 218‑7740 between 9 a.m. and 5 p.m. Eastern Time, Monday through Friday (except federal holidays).

The regulations governing negotiability proceedings are in 5 C.F.R. part 2424, and are available here.

On receipt of the petition for review, a representative of the Authority will schedule a conference concerning this petition. 

Part I     Background Information

1.     Name and address of Petitioning Union:

2.     Union Representative Contact Information:

Name:

Title:

Address (if different from Question 1):

Phone:                          

Fax:

Email:

3.     Name and address of Agency:

4.     Agency Bargaining Representative Contact Information:

Name:

Title:

Address (if different from Question 3):

Phone:                         

Fax:

Email:

5.     Agency Head or Agency Head Designee Contact Information:

Name:

Title:

Address (if different from Question 3):

Phone:                         

Fax:

Email:

6.     How many provisions are in dispute?

7.     What was the date of the Agency Head disapproval?

i.     Attach a copy of the disapproval.

8.     Are there or were there any related Court, FLRA, Federal Service Impasses Panel (FSIP), or other proceedings concerning the same provision?

  [  ] Yes      [  ] No

8a.     If Yes, which of the following proceedings?

i.     An unfair labor practice charge

  [  ] Yes      [  ] No

If Yes, explain in detail how the unfair labor practice charge is related to this negotiability proceeding and provide the following:

What date was it filed?

What is the status of the case?

What is the case number?

ii.     A proceeding before the FSIP

  [  ] Yes      [  ] No

If Yes, explain in detail how the proceeding before FSIP is related to this negotiability proceeding and provide the following:

What date was it filed?

What is the status of the case?

What is the case number?

iii.     A related petition for review of negotiability issues

  [  ] Yes      [  ] No

If Yes, explain in detail how the petition for review of negotiability issues is related to this negotiability proceeding and provide the following:

What date was it filed?

What is the status of the case?

What is the case number?

iv.     A related grievance

  [  ] Yes      [  ] No

If Yes, explain in detail how the grievance is related to this negotiability proceeding and provide the following:

What date was it filed?

What is the status of the case?

What is the case number?

Part II     Alternative Dispute Resolution (ADR)

The Authority offers ADR services to help parties resolve their negotiability disputes through our partenership with the Federal Mediation and Conciliation Service.  ADR provides an alternative to traditional case processing.  If you are interested in ADR assistance or information regarding any of its services, you may contact the office of Case Intake and Publication at (202) 218-7740, or exploreadr@flra.gov.

9. Are you interested in attempting to resolve this matter with the assistance of ADR?

  [  ] Yes      [  ] No

Part III     The Provisions

For each provision answer questions 10 through 14.  Provide separate answers for each provision.

PROVISION                          

10.     Set out the exact wording of the provision sought to be declared legal.

11.     Explain the meaning of the provision including: any special terms or phrases, technical language, or other words that are not in common usage.

12.     Describe how the provision is intended to work and what impact it will have. Where a provision has previously been included in the parties' collective-bargaining agreement, describe how the provision has worked and what impact it had. Where the provision concerns a particular work situation, or other particular circumstances, describe the situation or circumstances that will enable the Authority to understand how each provision is intended to apply.

13.     If the Agency Head has explained the basis of any allegation that the provision is illegal, you may choose to attach a statement describing your legal arguments concerning the legality of these provisions. You may also wait and provide your arguments in response to the Agency's statement of position. If you choose to provide your legal arguments with this petition, you may explain, but not change, those arguments in later filings.

For all statements, cite any law, rule, regulation, section of a collective-bargaining agreement, or other authority relied on in your argument or referenced in the provision.  Attach to this petition a copy of all such material, except you do not have to provide a copy of federal statutes, government-wide regulations, or judicial and administrative decisions.

If your statement is more than 10 pages long, you must include a table of contents.

Are copies of materials attached?

  [  ] Yes      [  ] No

If yes, list the materials attached:

14.     Do you wish to "sever" any part of the provision?  Severing a provision into separate parts makes each part the subject of a separate determination regarding its legality.  Severance requires that each part has independent meaning, and should be sought only where you have an interest in determining whether any of the separate parts is legal even if the other part is not.

  [  ] Yes      [  ] No

14a.     If Yes, specify which provision you wish severed, how it is to be severed, and the independent meaning of the severed part.

Part IV     Hearing

15.     Do you believe that a hearing or other fact-finding procedure is necessary to resolve any issues presented in this case?

  [  ] Yes      [  ] No

15a.     If Yes, explain what those issues are and why they require a hearing.

Part V     Responsibilities of the Union

After filing the petition for review, the Union is responsible for participating in a conference and responding to any Authority Order.

Failure to participate in a conference under section 2424.23 of the Authority's Regulations, a direction or proceeding under section 2424.31 or otherwise failure to provide timely or responsive information pursuant to an Authority Order may result in dismissal of the petition for review. 5 C.F.R. § 2424.32.

Part VI     Checklist with Statement of Service and Signature

All documents filed with the Authority must comply with the requirements set forth in part 2429 of the Authority's Regulations.

A complete copy (including all attachments) of a petition for review must:

• Be served by certified mail, first-class mail, commercial delivery, in person, or email (but only when the receiving party has agreed to be served by email) on:
       (1) the Principal Agency Bargaining Representative at the negotiations; and
       (2) the Head of the Agency (or designee)  (5 C.F.R. §§ 2424.2(g) & 2429.27(b))
• Contain a signed and dated statement of service with names and addresses of parties served, date of service, nature of document served, and whether by certified mail or personal delivery (See below)  (5 C.F.R. § 2429.27(c))
• Contain an original and 4 complete and legible copies of all documents  (5 C.F.R. § 2429.25)
• Be addressed to:

Case Intake and Publication
Federal Labor Relations Authority
Docket Room, Suite 201
1400 K Street, NW.
Washington, D.C. 20424-0001

Statement / Certificate of Service to be used by Union in filing a petition for review of negotiability issues.

---

STATEMENT OF SERVICE

I certify that a complete copy of the position for review, including all attachments, in the case of the [UNION and AGENCY], case number __________, were filed with the Office of Case Intake and Publication, Federal Labor Relations Authority, Washington, D.C., and were sent this day to:

Agency Principal Bargaining Representative
(Title and Mailing Address)
(The Principal Bargaining Representative is the
individual who signed the Agency allegation.)

 

The Head of the Agency (or designee) */
(Title and Mailing Address)

 

Indicate near each name the Method of Service

 

_______________                              __________________
Date                                                     Name of filing party

__________________
Signature of Union's representative

 

 

*/ For example, for components of the U.S. Department of Defense, the Head of the Agency (or "Agency Head") is the Secretary of Defense, or his or her designee.