UNITED STATES DEPARTMENT OF JUSTICE
Office of the Inspector General
WARNINGS AND ASSURANCES TO EMPLOYEE REQUIRED
TO PROVIDE INFORMATION
You are being asked to provide information as part of an investigation being conducted by the Office
of the Inspector General. This investigation is being conducted pursuant to the Inspector General
Act of 1978, as amended.
This investigation pertains to
You have a duty to reply to the questions posed to you during this interview and agency disciplinary
action, including dismissal, may be undertaken if you refuse to answer or fail to reply fully and
truthfully.
Neither your answers nor any information or evidence gained by reason of your answers can be
used against you in any criminal proceeding. However, if you knowingly and willfully provide false
statements or information in your answers, you may be criminally prosecuted for that action. The
answers you furnish and any information or evidence resulting from them may be used in the
course of agency disciplinary proceedings.
ACKNOWLEDGMENT
I have read and understand my rights and obligations as set forth above.
Signature of the Office of the Inspector Employee's Signature
General Special Agent
Name of the Office of the Inspector Employee's Name
General Special Agent
Signature of Witness Date and Time
Name of Witness Place
OIG Form III-226/3 (05/03/21), Warnings andAssurances to Employee Required to Provide Information
EFTA00025226