Missouri National Guard > Programs

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)

CONTACT US

FEDERAL TECHNICIANS
To file a grievance, please contact the MONG Labor Relations Specialist at 573-638-9643

131 BW/IG
Walk-In Location: Whiteman AFB, Building 509, Room 105 (Drill Weekend Only)
Email- 131.BW.FAL.Wing.IG.Office@us.af.mil
Office Phone (Drill Weekend Only) - (660) 687-5130
Phone (all hours) - (636) 448-4024

139 AW/IG Complaints Resolution
Walk-In Location: Rosecrans Air National Guard Base
St. Joseph, MO Bldg. 51, Room 130
Email- 139.AW.IGQ.Org@us.af.mil
Phone- 816-236-3089; DSN 356-3089

IG Action Request Form

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

When did the incident occur (dates)?

Have you requested assistance from another Agency, IG, Source pertaining to the incident? (If so, with who & what was communicated)

List POCs/Witnesses that have knowledge of your incident.

List the names within your chain of command/supervision that you have addressed this matter with prior to contacting the IG.

Is this complaint against a person? (identify additional persons in the next section)

Please identify first, last name, office and title.

Describe the incident; and what standard, rule, regulation, law was violated.

First Name

Middle Initial

Last Name

DoD ID number

You can find your DoD ID number displayed on the back of your Common Access Card (CAC)

Affiliation (NGB or State/Territory)

Grade/Rank

Service

Status

Unit and Complete Military Address

Preferred Contact Telephone

Duty, home, and / or cell

Preferred Mailing Address

If different from military address, including ZIP code

E-mail Address

I consent to release my personal information outside of IG channels (but within DoD official channels) in order to resolve the matters listed above. I understand that if I do not agree to release my personal information, my request for assistance may go unresolved.

I allow to release my personal information
I do not allow to release my personal information*

I do/I do not 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.

I consent to release the documents
I do not consent to release the documents*

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).

1-573-638-9500	POLICY LINKS
Missouri National Guard	Privacy and Security
2302 Militia Drive	External Links
Jefferson City. MO 65101-1203	Web Policy
	DoD Information Quality
MEMBER RESOURCE LINKS	DoD Open Government
E-Mail Access (@army.mil)	FOIA
MyPay	No FEAR Act
MyBiz	Accessibility/Section 508
RAPIDS Site Locator	iSALUTE
iPerms	MONG's proposed rules

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