INSCOM Inspector General Action Request

This web form may be used to submit a report to the INSCOM IG. Although anonymous submissions are allowed, action cannot be taken on your behalf without sufficient identifying information. This form is not intended for general complaints, and should only be used in circumstances where the attention of the INSCOM IG is required.

Name*

First

Middle

Last

Grade

Rank

DoDID

Component

Status

Unit and Complete Military Address

Preferred Mailing Address (If different from military address. Include Zip)

Preferred Contact Telephone

E-mail Address:

Specific Action Requested (What do you want the IG to do for you?) (Required)*

List the name, duty position and phone number for each individual you have addressed the issue(s) with (Chain of Command, supervisor(s), MER, CPAC/CPOC, Patient representative, IG, Member of Congress, other) and what did they do for you? (Required)*

Who else has information relevant to you issue(s) (witnesses names and phone numbers)? (Required)*

Does your complaint involve classified information? (Required)*

Do you give permission for the IG to use your name on your behalf? (Required) *

Please describe in detail the issue(s) for which you want IG assistance: ** Disabled when classified.

Do you have any attachments? If Yes, the IG will contact you.

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

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

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 USC 1001).

If you are not contacted by the INSCOM IG within 72 duty-hours of submitting your request, please call our office @ 571-515-7439 or usarmy.belvoir.inscom.list.ig-assistance-and-investigation@army.mil.