Request for Funding for Legal Advice Form

Submit completed form by mail, fax or in person to:

Office of the Public Sector Integrity Commissioner of Canada 
60 Queen Street, 4^th Floor 
Ottawa, Ontario  K1P 5Y7

613-941-6400 or 1-866-941-6400 (toll-free) 
Fax: 613-946-2151 (not a secure means of transmission)

General Information

Under the Public Servants Disclosure Protection Act (the Act), you may be eligible to receive funding for legal advice. The Office of the Public Sector Integrity Commissioner (PSIC) may grant access to legal advice, under the following terms:

• You may be eligible to receive funding for legal advice if you are involved in a disclosure of wrongdoing or a reprisal complaint, whether you are a discloser or a complainant, a person under investigation or even a witness.
• You may also be eligible to receive funding for legal advice if you are considering making a disclosure of wrongdoing or a reprisal complaint.
• You can obtain legal advice from the lawyer of your choice.
• The maximum amount to be paid for legal advice is $1,500, or up to $3,000, under exceptional circumstances.
• In determining the amount to be paid for legal advice, the public interest and the degree to which you may be adversely affected will be taken into account.
• You must not have access to free legal advice by other means
• If you are considering making a disclosure of wrongdoing (either to your employer or to the Commissioner), but have not already done so, access to legal advice may be provided only if the subject of your disclosure likely constitutes wrongdoing and is likely to lead to an investigation under the Act.
• If the Commissioner approves your request for access to legal advice, our Office will not reimburse you directly; we will only pay your lawyer directly, to the maximum approved by the Commissioner, on presentation of an invoice (instructions will be provided to you and to your lawyer accordingly).

General Contact Information

Name: 
Job title or Rank (RCMP): 
Current employer: 
Current Branch or unit: 
Address where you would like to be contacted (does not have to be your work address): 
Telephone number(s): 
Fax (optional): 
Official language of choice for correspondence: English   French 
Email*:

*NOTE:  The Office of the Public Sector Integrity Commissioner does not accept reprisal complaints or disclosures of wrongdoing via e-mail due to security and privacy concerns. The majority of communication between the Office and you will be undertaken via regular mail correspondence or by telephone. However, for increased convenience, correspondence regarding basic status update of files or setting up interviews may be sent by email.

Are you or were you previously employed in the Federal Public Sector?

Yes

No

If yes, provide the organization’s name, work unit and branch: 
 

Reasons for Requesting Access to Legal Advice

1.  Please specify the name of the organization involved where the alleged wrongdoing or reprisal occurred:

2.  Are you considering making a disclosure of wrongdoing either internally to your employer (if applicable) or to PSIC, but have not done so yet?

Yes

No

If you answered yes, describe in detail the allegations of wrongdoing that you are considering disclosing:

NOTE: please include specific information about the alleged wrongdoing (i.e. where and when the events took place and what happened):

3.  Are you a current or former public servant considering making a reprisal complaint?

Yes

No

If you answered yes, describe the nature of the reprisal complaint that you are considering making:

4.  Are you currently involved in a disclosure of wrongdoing?

Yes

No

If you answered yes, what is your involvement?

Person who disclosed wrongdoing

Witness

Person against whom the disclosure was made

Is your request for legal funding in relation to an internal disclosure of wrongdoing (made internally to an employer) or a disclosure made to PSIC?

Employer

PSIC

If the disclosure was made to PSIC, please specify the PSIC file number (e.g. PSIC-2016-D-0000) (if known): 

If the disclosure was made internally to a federal public sector employer, please provide details about the disclosure (include relevant dates, the nature of the wrongdoing and the status of any related investigation or decision).

5.  Are you currently involved in a complaint of reprisal that was made to PSIC, including in an investigation or proceeding before the Public Servants Disclosure Protection Tribunal?

Yes

No

If you answered yes, what is your involvement?

Complainant

Witness

Person against whom the complaint was made

If you answered yes, please specify the PSIC file number (e.g. PSIC-2016-R-0000) or 
Tribunal file number:

6.  Amount requested

up to $1,500

up to $3,000 in exceptional circumstances

Describe the circumstances and reasons for your request, including any exceptional circumstances that you believe the Commissioner should consider?

7.  Have you already consulted a lawyer about this disclosure or reprisal complaint: 

Yes

No

If yes, please state the date on which legal services were first provided and the name of the lawyer, law firm, address, as well as telephone and fax numbers. Attach any invoices received from the law firm.

Date services first provided: 

Lawyer’s contact information:

Legal Advice from Other Source(s)

8.  Are you member of a union or a professional association?

Yes

No

If yes, name of union or association? 

If you answered yes, have you requested access to legal advice from your union or professional association about this matter?

Yes

No

If yes, what was the response?

Granted

Denied

9.  Have you requested access to legal advice from your employer about this matter?

Yes

No

If yes, what was the response?

Granted

Denied

10.  If you made a request to your union/association or employer that was granted or denied, please provide details of the response received, including relevant dates and names of officials. If you did not contact your union/association or employer, tell us why you did not do so.

Declaration

I declare that all the information provided in the current request is true.

Signature 
Date

NOTE: By submitting the Request for Legal Advice Form, you are authorizing the Office of the Public Sector Integrity Commissioner to collect your personal information.

This information is being collected solely for purposes related to the application of the Public Servants Disclosure Protection Act. Accordingly, a representative from the Commissioner’s Office may contact you for further information.

This information is held under Personal Information Bank PSIC PPU 005 and you have a right to access this information in accordance with the Privacy Act.