11th Airborne Division > Resources > Inspector General

ELECTRONIC IG ACTION REQUEST FORM

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DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY: 10 U.S.C. 7013, Secretary of the Army; 10 U.S.C. 7020, Inspector General; Inspector General Act of 1978, Public Law 95-452, 92 Stat. 1101 (1978), as amended; DoDD 1030.1, Victim and Witness Assistance; AR 20-1, Inspector General Activities and Procedures.

PRINCIPAL PURPOSE: To secure information sufficient to inquire into the matters presented, to take action to correct deficiencies, and to respond to requesters.

ROUTINE USES: Information is used for official purposes within the Department of Defense; to answer complaints or respond to requests for assistance, advice, or information; by Members of Congress and other Government agencies when determined by the Inspector General to be in the best interest of the Army; and, in certain cases, in trials by court-martial and other military matters as authorized by the Uniform Code of Military Justice.

DISCLOSURE: Voluntary. However, failure to provide complete information may hinder proper identification of the requester, accomplishment of the requested action(s), and response to the requester.

SORN: A0020-1 SAIG, Inspector General Records (January 11, 2002, 67 FR 1447)

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Requred

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DO YOU WISH TO REMAIN ANONYMOUS?

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Note: If you file a Inspector General Action Request anonymously, we will be unable to contact you to obtain more information about the case or provide you the results if we conduct an investigation.

Name

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DOD ID (Leave blank if you do not have a DOD ID)

Preferred Contact Telephone

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Confirm

Do you belong to any of these Units?

Complete Military Address (If applicable)

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PREFERRED MAILING ADDRESS (If different from military address, including ZIP Code)

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Component/Duty Status

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Please list the rank, name, unit and contact information of any other subjects (limit 200 characters)

What did the subject do, or fail to do, that was wrong? (limit 500 characters)

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What rule, regulation, or law do you believe the subject(s) violated? (Limit 500 characters)

Have you sent your complaint to a Member of Congress? (If yes, please provide information below)

Name(s) of Congressperson(s) and date(s) you contacted them (Limit 250 characters)

Where did the incident take place? What location, command, etc.? (Limit 800 characters)

Why do you think the incident took place? (Limit 800 characters)

How have you tried to resolve the problem? (Limit 800 characters)

Who else do you believe has information regarding this request? Add contact information if possible. (Limit 500 characters)

This information is submitted for the basic purpose of requesting assistance, correcting injustices affecting the individual, or eliminating conditions considered detrimental to the efficiency or reputation of the Army. Those who knowingly and intentionally provide false statements on this form are subject to potential punitive and administrative action (UCMJ Art 107, 18 U.S.C. 1001).

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