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: p
your allescd --k-a1se 'per 4cresyNan te
gy.:,kvIre cer,,,e;hi rralivre a net cepa( t;03 4.1ce_, tn4 rmo,.1ton.
This is a voluntary interview. Accordingly, you do not have to answer questions. No disciplinary
action will be taken against you if you choose not to answer questions.
My 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
Signature of the Office o(tp) Inspector Employee's Signature
General Special Agent
Name nf the Offire nf the Incnertnr Employee's Name
6- 11-ai 0:11 am
ture •f Witness Date and Tirry#
Name of Witness
OIG Form 01-226/2 (05/03/21) Non-CustodieEmployee
EFTA00064005