OIG Hotline Identified Complaint Form

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

This level of confidentiality is appropriate for complainants seeking personal relief, such as veterans, dependents, and contractors, or for complainants comfortable being identified if needed regarding concerns involving VA programs and operations.

Return to the Disclosure Options When Submitting a Complaint page for more options.

VA employees, VA contractors, and any other HIPAA-covered individuals or entities (e.g., private healthcare providers and insurance providers) should not submit personally identifiable information, protected health information (PHI), or other VA-sensitive information (including patient names) via this web submission form. If submission of VA sensitive information or other PHI is required, please contact the VA OIG Hotline at 1-800-488-8244 to determine how to submit it. Additional information is available on the Hotline FAQ page.

Contact Information

A red asterisk (*) indicates a required field.

First Name*

First Name is Required

Last Name*

Last Name is Required

Title

Address

City

State

Zip Code

Please contact me by:

Telephone Number*

Telephone Number is Required

Email Address*

Email Address is Required

Leave Blank

Complaint

VA Office or Facility Involved

VA Office or Facility exceeds maximum number of characters.

Alleged legal or policy violation(s) or other misconduct

Alleged legal or policy violations exceeds maximum number of characters.

Effect of the wrongdoing, such as dollars lost, delay produced, etc.

Effect of Wrongdoing exceeds maximum number of characters.

Names of Wrongdoers

Names of Wrongdoers exceeds maximum number of characters.

Names of Victims

Date(s) when the event(s) occurred

Dates of event exceeds maximum number of characters.

Names of witnesses

Names of Witnesses exceeds maximum number of characters.

Has this allegation been previously reviewed?

If yes, please provide the dates and who did the review

Previously Reviewed comments exceeds maximum number of characters.

Have you contacted the VA OIG about this issue before?

If yes, please provide date contact was made and to whom

Previous Contact comments exceeds maximum number of characters.

Additional Comments

Additional Comments exceeds maximum number of characters.

Attachments

Filename	Size

Total File Size:

Sensitive Records

VA Employees should not send VA medical records or similar VA sensitive records via this portal.

Submit Form

By submitting this form, I agree that the VA OIG can disclose my name and other information I provide, if necessary, in order to ensure my issues are addressed. Return to the Complainant and Identity Release Preference Page for more options.

OIG Hotline Identified Complaint Form

Attaching Files

Sensitive Records