EPA OIG Hotline Complaint Form (original) (raw)

Type of Complaint

General

I am providing my name and I agree that EPA OIG can disclose my name and other information I provide, if necessary, to ensure my issues are addressed.

Confidential

I wish to be confidential, meaning I am providing the OIG my name, but I request that the OIG not disclose my name outside the OIG. This option is appropriate for complainants who fear reprisal.

Anonymous

I wish to be anonymous, meaning the OIG will not know my name. If I make this selection, I understand that the OIG will not be able to contact me, and the OIG may not have enough information to pursue my concerns.

Full Name

Phone Number

Your Title and Position

Alleged Wrongdoer Information

What is the title/position held by the alleged wrongdoer?

Provide names, addresses, and telephone numbers of all subjects.

If providing information concerning contractor or grantee fraud, please provide the name of the primary contractor and/or subcontractor, type of contract, contract or grant numbers, date of award, and the name of any agency officials.

Incident Information

Provide a description of what occurred. What exactly did the individual(s) allegedly do wrong/how was the alleged wrongdoing committed? (Please provide specific and relevant details concerning the alleged misconduct/wrongdoing, to include any policies, regulations, and laws violated.)

Provide the date(s) and time(s) of the wrongdoing.

How you are aware of the alleged wrongdoing? (Please include when and how you gained this knowledge.)

Where did the wrongdoing occur?

What was the effect of the wrongdoing? (Was there a loss to the government? Did anyone benefit/suffer from the wrongdoing?)

Provide the identity of potential witnesses. Who else might be aware of this wrongdoing and how does the individual know? (Please provide names, addresses, and telephone numbers.)

Supporting Documentation

Provide any supporting documents, photos, e-mails, etc.

Maximum 3 files.
2 MB limit.
Allowed types: jpg, png, txt, pdf, doc, docx.