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SIGNATURE DA FORM 1559 JUN 2018 DATE YYYYMMDD PREVIOUS EDITIONS ARE OBSOLETE. APD LC v1. 02ES Page 1 of 2. INSPECTOR GENERAL ACTION REQUEST For use of this form see AR 20-1 the proponent agency is the Office of The Inspector General* DATA REQUIRED BY THE PRIVACY ACT OF 1974 AUTHORITY 10 U*S*C 3013 Secretary of the Army 10 U*S*C 3020 Inspector General Act of 1978 Public Law 95-452 as amended DoDD 1030. 1 Victim and Witness Assistance AR 20-1 Inspector General Activities and Procedures. PRINCIPAL PURPOSE To secure sufficient information to inquire into the matters presented and to provide a response to the requester s and/or take action to correct deficiencies. 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 trial by courts-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 LAST FIRST MIDDLE INITIAL GRADE / RANK DOD ID COMPONENT / STATUS Select One UNIT AND COMPLETE MILITARY ADDRESS Point of Contact/Telephone if applicable PREFERRED CONTACT TELEPHONE Duty home and / or cell PREFERRED MAILING ADDRESS If different from military address including ZIP Code E-MAIL ADDRESS Optional SPECIFIC ACTION REQUESTED What do you want the IG to do for you INFORMATION PERTAINING TO THIS REQUEST Background. Use additional sheets if necessary list enclosures if applicable. 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 above. I understand that if I do not release my personal information my request for assistance may go unresolved* 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 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 U*S*C 1001. INSPECTOR GENERAL ACTION REQUEST For use of this form see AR 20-1 the proponent agency is the Office of The Inspector General* DATA REQUIRED BY THE PRIVACY ACT OF 1974 AUTHORITY 10 U*S*C 3013 Secretary of the Army 10 U*S*C 3020 Inspector General Act of 1978 Public Law 95-452 as amended DoDD 1030. 1 Victim and Witness Assistance AR 20-1 Inspector General Activities and Procedures. PRINCIPAL PURPOSE To secure sufficient information to inquire into the matters presented and to provide a response to the requester s and/or take action to correct deficiencies. .

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