Indicates required field Part One - Confidentiality Information Disclosure election (required) Consent to Disclosure: I consent to disclosure of my identity outside the OIG on a need-to-know basis. Non-Consent to Disclosure (Confidential): I do NOT consent to disclosure of my identity outside the OIG. I understand that if the OIG determines the allegation(s) I report cannot be investigated without disclosing my identity on a need-to-know basis to organizations outside the OIG, my lack of consent may prevent further action from being taken on my complaint. Anonymous: I am NOT providing my identity. Information About You First Name: Last Name: Phone Number: Email: Mailing Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Employee Status - None -AOC EmployeeAOC ContractorCongressional EmployeePrivate CitizenOther Government Agency May we contact you? Yes No Preferred method of contact: Phone Email Part Two - Allegation Details Allegation Narrative: In the text box above, please provide a summary of your complaint, to include what, when, where, why and how. For example: What did the subject do or fail to do that was wrong? Provide specific details regarding the wrongdoing. When did the alleged wrongdoing occur? Where did the alleged wrongdoing occur? What rule, regulation or law do you believe was violated? How and when did you learn of the suspected wrongdoing? Do you have firsthand knowledge of the events? If alleging contractor or procurement fraud, provide details of the contract or procurement, to include: contractor, purchasing agent or company; type of contract; contract number or title; name of agency officials involved in issuing the contract. Do you have supporting documentation? If supporting documentation exists outside your control, where can that documentation be found? Names and contact information for other individuals who are aware of the wrongdoing. Supporting Documentation If you have supporting documentation that you wish to provide with this complaint form, please utilize the option below. Do not send classified documents using this unclassified Internet system.One file only.2 MB limit.Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 mp4 ogg wav bz2 dmg gz jar rar sit svg tar zip. Other Actions You Are Taking Yes No Have you filed your complaint with any other office, to include other Inspector General offices, other law enforcement agencies, AOC management or program officials, or an AOC office? Agency or Office Complaint Filed With Your understanding of current complaint status? A description of responses received from other offices regarding the complaint Part Three - Certifications Please check the boxes below to certify that you agree with the following statements. I certify that all the statements made in this complaint are true, complete, and correct to the best of my knowledge. I understand that a false statement or concealment of a material fact is a criminal offense (18 U.S.C. § 1001). I have provided my election concerning my filing status in Part I of this form (Consent to Disclosure, Non-Consent to Disclosure, or Anonymous). If I did not provide my disclosure election, I understand that this will cause a delay in the processing of my complaint. I understand that if the Inspector General determines that the allegation(s) in my complaint cannot be investigated without disclosing my identity on a need-to-know-basis to organizations outside the AOC OIG, my lack of consent may prevent further action from being taken on my complaint. I further understand that even if I elect confidential status, pursuant to § 7(b) of the Inspector General Act of 1978, as amended, my identity may be disclosed if the Inspector General determines that such disclosure. Please check the boxes below to certify that you agree with the following statements. CAPTCHA: enabled to secure this form. If you are having difficulty using Captcha's visual option, please visit the Accessibility page for more assistance.
