This form is intended for members of the Uniformed Services (National Guard, Reserves, and the National Disaster Medical System (NDMS)), who are experiencing civilian employment concerns related to uniformed service obligations.
Employer Support of the Guard and Reserve (ESGR) is an office within the Department of Defense which informally mediates employment concerns between civilian employers and their National Guard, Reserve, and/or NDMS employees. Conflicts involving alleged Uniformed Services Employment and Reemployment Rights Act (USERRA) complaints are mediated through the efforts of ESGR's Volunteer Ombudsmen in all 50 states and 4 territories. The communications made by parties during informal mediation are protected by the Administrative Dispute Resolution Act (5 U.S.C. ??571-583) and may not be released without written authorization by all parties involved in the mediation.
If you believe your rights under USERRA have been violated by your employer, you can call 1-800-336-4590 (option one) between 8am and 6pm Eastern Standard Time to speak with an ESGR representative or you may fill out the form below. An ESGR representative will contact you.
If you have any questions regarding the request and processing, please e-mail us at osd.USERRA@mail.mil or call 1-800-336-4590 (option 1).
Please note: If, after 4 days of initial contact, your assigned Ombudsman has not heard from you, your case may be closed. A new case can be opened when you are available to discuss your concerns with your assigned Ombudsman.
If you believe your rights under USERRA have been violated by your employer, you can call 1-800-336-4590 (option 1) between 8 AM and 6 PM Eastern Time (M-F) to speak with an ESGR representative or you may fill out the form below. An ESGR representative will contact you.
Please note: If after 4 days of initial contact, your assigned Ombudsman has not heard from you, your case will be closed. A new case may be opened when you are available to discuss your concerns with your assigned Ombudsman.
Items marked with an asterisk (*) are mandatory.
Please note: This form takes 20-30 seconds to submit. Please only click the Submit button once. Once submitted, you will be directed to a completion page and receive a confirmation email.
The public reporting burden for this collection of information, 0704-ERRA, is estimated to average of less than five minutes per response, including the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
AUTHORITY: 38 U.S.C. 43, Employment and Reemployment Rights of Members of the Uniformed Services; 5 U.S.C. 574, Confidentiality; 5 U.S.C. Part I, Chapter 5, Subchapter IV, Alternative Means of Dispute Resolution in the Administrative Process; 42 U.S.C. 300hh-11,National Disaster Medical System, ((d)(3) Employment and reemployment rights); 20 CFR 1002, Regulations Under the Uniformed Services Employment and Reemployment Rights Act of 1994; 5 CFR 353, Restoration to Duty from Uniformed Service or Compensable Injury; DoD Instruction 1205.22, Employer Support of the Guard and Reserve; and DoD Instruction 1205.12, Civilian Employment and Reemployment Rights of Applicants for, and Service Members and Former Service Members of the Uniformed Services.
PRINCIPAL PURPOSE(S): To record information related to the mediation of disputes and answering of inquiries related to the USERRA; by tracking case assignments and mediation results of potential conflicts between employers and the National Guard, Reserves, or National Disaster Medical Service (NDMS) members they employ; and by reporting statistics related to the Ombudsman Program in aggregate and at the state committee-level. These records are also used as a management tool for statistical analysis, tracking, reporting, evaluating program effectiveness and conducting research.
Routine Use(s): Disclosure of records are generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended. To the Department of Labor for Congressionally-mandated USERRA reporting (38 U.S.C. Employment and Reemployment Rights of Members of the Uniformed Services, section 4432, Reports) with consideration of 5 U.S.C. § 574, Confidentiality requirements. Additional routine uses are listed in the applicable System of Records Notice, DHRA 16 DoD, Inquiry and Case Management System (ICMS), and is located at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570696/dhra-16/.
Disclosure: Voluntary; however, failure to provide accurate contact information and other solicited information may delay or prevent ESGR from processing the request.