New York National Guard Inspector General Assistance Request Form

Please read this Privacy Act Information before submitting this form.
You should make an effort to use your unit and chain of command to resolve issues BEFORE contacting the IG.
Disclosure of any information you enter on this form is voluntary. However, failure to provide complete, information may hinder proper identification of and response to the requestor (you) and accomplishment of the requested action(s).

** Denotes a required field.

I will include my contact information with this request for assistance and I consent to the release of all information and supporting documents i provide here outside IG channels to the chain of command or other DoD officials in order to resolve the complaint(s) included below.

I will include my contact information with this request for assistance, but do not consent to this information being released outside of IG channels (i.e. - information can only be used to contact me) The IG will not be able to use your information for any actions, including actions that may help resolve your complaint(s). You have the ability to alter this decision after your request has been made. We may contact you to discuss this option.

I will make this request for assistance anonymously By submitting this form anonymously, you will not be asked for any personal information, however, choosing this option also precludes the use of your personal information to be used by the IG for any purpose, including any actions that may help solve your complaint(s). Furthermore, we will have no way to contact you with any questions or feedback.

Contact Information

Name:**

Email:**

Phone #:

Address

Address:

City:

State:

Zip:

Service Information

Current Duty Status:**

Branch:

Rank:

Unit:

Complaint Details** (Be specific and provide supporting information - i.e. who, what, where and when)

What do you want the IG to do for you? ** (Be specific - tell us what you want us to do about your complaint)

To whom have you spoken about this matter? ** Identify (First Sergeant, Company Commander, etc.) I have not spoken to anyone yet about this matter

Do you have any supporting documentation? ** (Must be prepared to submit when an IG contacts you)

Have you requested assistance from any other source or agency? ** (e.g. Military Personnel or your Senator) No previous assistance requested

Acknowledgement

I certify that all of 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; Inspector General Act of 1978; As Amended, § 7).

By submitting this form, you acknowledge that you have read and understand the Privacy Act Information.

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Inspector General Assistance Request Form

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New York National GuardInspector General Assistance Request Form