Hotline Complaint Report | Armed Forces Retirement Home

Part 1. Your Current Information

Please select one

Identity Release

I acknowledge that if AFRH determines my complaint cannot be investigated without disclosing my identity on a need-to-know basis, my lack of consent may prevent further action from being taken on my complaint. I further understand that even if I elect confidential status, my identity may be disclosed, if required by applicable legal authority, or AFRH, determines that such disclosure is otherwise unavoidable.

Last Name

First Name

Middle Name

Suffix

AFRH Job Title/Resident/Family Member etc.

Other Agency or Office

Email Address

Telephone Number

Interview

Are you submitting this complaint for someone else? *

Is that person aware you are submitting this complaint? *

What is that person’s last name?*

What is that person’s first name?*

What is their AFRH Job Title/Resident/Family Member etc?*

What is their email address?

What is their telephone number?

Part 2. Complaint Details

Use this section to clearly describe your complaint.

Is this complaint against a person? *

Identify the person(s) that committed the alleged wrongdoing. (* required)

Person #1

Last Name

First Name

AFRH Job Title/Resident/Family Member etc.

Email Address

Telephone Number

Person #2

Last Name

First Name

AFRH Job Title/Resident/Family Member etc.

Telephone Number

Email Address

If not a person, or need to add more subjects, please explain here: (1500 charter limit)

Provide an Accurate Summary of your Complaint

We can best process your complaint if you submit accurate and complete information. Provide a summary of your complaint, to include an event chronology, if appropriate. Be as specific as possible in your responses. (* required)

Explain the incident, alleged wrongdoing/complaint. (5000 charter limit) *

When did the incident or alleged wrongdoing occur?*

Where did the incident or alleged wrongdoing take place?*

Identify the KEY witness(es) who may have information of the alleged wrongdoing.

Witness #1

Last Name

First Name

AFRH Job Title/Resident/Family Member etc.

Email Address

Telephone Number

Witness #2

Last Name

First Name

AFRH Job Title/Resident/Family Member etc.

Email Address

Telephone Number

If you need to add more witnesses, please list them here: (1500 charter limit)

What law, rule, regulation, or standard do you believe was violated? (1000 charter limit)

Briefly summarize how our office can assist you regarding this matter. (500 charter limit)

Part 3. Other Actions You Are Taking

Indicate in this section if you have filed your complaint with any other office, to include other Inspector General offices, or a member of Congress. If you have received any response(s) from those offices, provide our office with a copy.

Have you reported this matter to any other organization/agency? *

Where did you submit?*

When did you submit?*

Part 4. Document Uploads

Mail this form along with any support documentation to:

Armed Forces Retirement Home
Office of Inspector General
3700 North Capitol Street, NW
Sherman Building, Room 104
Washington, DC 20011

Or you may submit via facsimile to: 202-541-7511

Part 5. Certification *


I certify that all of the statements made in the complaint are true, complete, and correct, to the best of my knowledge.	I certify that all of the statements made in the complaint are true, complete, and correct, to the best of my knowledge.

Math Question: 9 + 8 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.