Get DA 1559 2021-2024

14. SIGNATURE 15. DATE YYYYMMDD 16. IG / INTAKE REMARKS DA FORM 1559 APR 2021 PREVIOUS EDITIONS ARE OBSOLETE. APD AEM v1. UNCLASSIFIED 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 10 U*S*C. 7013 Secretary of the Army 10 U*S*C. 7020 Inspector General Inspector General Act of 1978 Public Law95-452 92 Stat. 1101 1978 as amended DoDD1030. 1 Victimand Witness Assistance AR20-1 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 AUTHORITY 1. LAST FIRST MIDDLE INITIAL 2. GRADE / RANK 3. DOD ID 4. COMPONENT / DUTY STATUS 5. PREFERRED CONTACT TELEPHONE Duty home and / or cell 6. E-MAIL ADDRESS ES PointofContact/Telephoneifapplicable 7. UNITANDCOMPLETEMILITARYADDRESS Ifdifferentfrommilitaryaddress includingZIPCode 8. PREFERREDMAILINGADDRESS 9. SPECIFIC ACTION REQUESTED What do you want the IG to do for you 10. HAVE YOU CONTACTED YOUR CHAIN OF COMMAND OR ANY AGENCY CONCERNING Explainfor bothyesandnoresponses. THIS REQUEST Yes No 11. INFORMATION PERTAINING TO THIS REQUEST Be specific and detailed* List any supporting documentation or enclosures if applicable. 12. I do consent to release my personal information outside of IG channels to the chain of command or other officials but within I do not DoD channels in order to resolve the matters listed above. I understand that if I do not consent to the release of 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 consent to the release of 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 considereddetrimental totheefficiencyor reputationof theArmy. Those whoknowinglyandintentionallyprovidefalse statementsonthis formaresubject to potential punitiveandadministrative action UCMJArt 107 18 U*S*C1001. UNCLASSIFIED 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 10 U*S*C. 7013 Secretary of the Army 10 U*S*C. 7020 Inspector General Inspector General Act of 1978 Public Law95-452 92 Stat.