Air IG Action Request

Air IG Action Request Form

AUTHORITY: 10 U.S.C. 8013 Secretary of the Air Force, 10 U.S.C. 8020 Inspector General, 44 U.S.C. 3101 Records Management, Air Force Instruction 90-301, Inspector General Complaints Resolution and EO 9397.

PRINCIPAL PURPOSES(S): To register a personal complaint relating to individual injustices or suspected Fraud, Waste, and/or Abuse.

ROUTINE USE(S): Data provided are furnished to supervisors, commanders or inspectors in response to queries for resolution of complaints and to eliminate conditions considered detrimental to the efficiency or reputation of the Air Force.

DISCLOSURE: Voluntary; However, failure to provide the information will not adversely affect the resolution of your complaint but may delay the IG or investigating officer in resolving the issue.

SECTION I: COMPLAINANT IDENTIFICATION

1. (Last, First, Middle, Suffix) or Anonymous

2. Grade/Rank

3. Today's Date

4. DOD ID Number

5. Organization (Where does Complainant work)

6. Military Branch

7a. Home Telephone

7b. Cell Telephone

7c. Work Telephone

8. Status (At time of incident)

9. E-mail address (Where can IG contact Complainant)

10. Address (Where the response to complaint will be sent)

SECTION II: PRIOR ATTENTION TO ISSUE

11. Have you asked your immediate supervisor, chain of command, or commander for assistance with this issue?

YesNo

12. Have you filed this complaint with Congress or another IG?

YesNo

13. Have you filed this complaint with any other office or organization, such as Equal Opportunity (EO)?

Yes No

SECTION III: BRIEF SYNOPSIS OF ISSUES OR ALLEGATION (S)

14a. When: (When did the issue occur?)

14b. Calendar Date:

14c. When Aware: (Date you became aware of issues (s).)

14d. Calendar Date

15. (Where): Where did the issue occur?

16. Who took the action in question #17. (e.g., Maj John A. Smith, XXSQ/CC)

17.Did What: (What did the person (or people) in question #16 do (e.g., gave a letter of reprimand, wasted, abused authority, wasted resources, etc)

18. To Whom: (To whom did the action in question #17 happen (e.g., complainant, Sgt Jones, etc.)?)

19. In Violation of What: (What law or regulation was violated [e.g. AFI 36-2803, 10 U.S.C. 1034, etc]?)

20. Remedy: (What remedy is being sought?)

SECTION IV: LIST OF WITNESSES

21 Names and/or positions of witnesses: (List any witnesses or others who may have knowledge about this issue. Provide details about what the witness may know, as well as, contact information if the witness is not in your organization. List the witnesses in order of importance.

SECTION V: DETAILED NARRATIVE DESCRIPTION OF ALLEGATION(S) OR ISSUE(S)

22. Narrative Description: (Use this block to describe the issues and/or allegations in sufficient detail for the IG to process your complaint. This block will automatically expand to accommodate extensive text entries. If copying & pasting from another document, do not include any special characters (e.g., subscript, symbols, non-text and no-printing characters, etc.]. Do no paste any graphics into this form.

SECTION VI: COMPLAINT CERTIFICATION

23 Consent to Release: I DO I DO NOT consent to release of my name to any necessary agency outside the IG system under Controlled Unclassified Information (CUI) or other authorized policies to facilitate resolution of my complaint. I understand failure to authorize release may preclude timely resolution of my issues.

I DOI DO NOT

I certify that all of the statements made in this complaint (including any continuation pages) are true, complete, and correct to the best of my knowledge and belief. I understand that a false statement or concealment of a material fact is a criminal offense punishable under Article 107 of the UCMJ or 18 U.S.C. § 1001 by a fine of up to $250,000, imprisonment for up to five years, or both.

Note: You do not have the ability to apply your signature on this digital submission. When the IG contacts you, you will have the opportunity to confirm your identity, confirm your consent levels, and confirm your certification.

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