ELECTRONIC IG ACTION REQUEST FORM

BEFORE YOU FILE

Please read the information on our IG page to find answers for many questions you might have about filing an IG action request, or reference the Department of the Army IG website for their Frequently Asked Questions.
Ensure the issue is relevant to the Army. If it is relevant to a different military branch, please visit the DOD, Service and VA Inspectors General page on the Army IG's website to find the appropriate contact.
If possible, try to resolve the issue with your chain of command first. Remember, no one can tell you to not talk to an IG.
Gather all information you need (what, when, where, why, who). Clearly describe the issue you need assistance with.
Do not enter any classified information on the electronic IG Action Request form. If your communication to an IG involves classified information, you must read the DOD Classified Complaint page first.

OTHER FILING OPTIONS

Army IG Hotline

Toll-free: (800) 752-9747
DSN: (312) 865-1845

Army National Guard/NGB IG

Army Reserve/USARC IG

Do not enter any classified information on this form

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)

Do not enter any classified information on this form

Required fields are marked with a red asterisk *

NOTE: Attachments are prohibited for OPSEC reasons. You will have a chance to forward any supporting documentation after an IG contacts you about your inquiry.

DO YOU WISH TO REMAIN ANONYMOUS?*

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.

Rank/Title

NAME*

First

Middle

Last

Suffix

DOD ID

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

PREFERRED CONTACT TELEPHONE

(duty, home, and /or cell)

EMAIL ADDRESS*

Confirm

Do you belong to any of these Army organizations?

UNIT AND COMPLETE MILITARY ADDRESS (if applicable)

Unit Name

Street

City

State/Region

Country

Zip

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

Street

City

State/Region

Country

Zip

COMPONENT / DUTY STATUS

GRADE/RANK

I do / I do not consent to release my personal information outside of IG channels to the chain of command or other officials (but within DoD channels) in order to resolve the matters listed below. *

I understand that if I do not release my personal information, my request for assistance may go unresolved.

I do / I do not consent to release the supporting documents I provided to the IG (to exclude this DA Form) outside of IG channels to the chain command or other officials (but within DoD channels) in order to resolve the matters listed below.*

I understand that if I do not release my documents, my request for assistance may go unresolved.

ARE YOU WILLING TO BE INTERVIEWED?

What can the IG do for you? (limit 700 characters)*

Do you believe someone wronged you or violated a law, regulation, or policy? If so, who? {Subject(s)/Suspect(s)}
(Please fill out the information below as completely as possible)

Rank/Title

Name (Subject 1)

First

Middle

Last

DOD ID

PHONE

UNIT / ADDRESS

Unit

Street

City

State/Region

Country

Zip

COMPONENT / DUTY STATUS

GRADE / RANK

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)

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)*

NO
YES

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

When did the incident occur? Provide dates and times, if possible. (Limit 800 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).

I acknowledge the statement above (required)*

Acknowledge

SIGNATURE (Limit 45 characters)

Date, Time, and Time Zone

Time should be 24-hr Format using a colon (Ex. 12:30)

Submit