UNITED STATES DEPARTMENT OF JUSTICE
Office of the Inspector General
WARNINGS AND ASSURANCES TO EMPLOYEE REQUESTED
TO PROVIDE INFORMATION ON A VOLUNTARY BASIS
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:
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This is a voluntary interview. Accordingly, you do not have to answer questions. No disciplinary
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action will be taken against you you choose not to answer questions.
Any statement you furnish may be used as evidence in any future criminal proceedings or agency
disciplinary proceeding, or both.
WAIVER
I understand the warnings and assurances stated above and I am willing to make a statement and
answer questions. No promises or threats have been made to me and no pressure or coercion of
any kind has been used against me.
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Date and Time
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Name of Witness Place I 6444
OIG Form 111.226/2 (05/03/21) Non-CustodiaWmployee
EFTA00063394