OIG Hotline Confidential Complaint Form

I wish my identity to be kept confidential, meaning I am providing the OIG my name, but I request that the OIG not disclose my name outside the OIG.

This category is appropriate for complainants who fear reprisal for contacting the OIG. The OIG will protect the identity of complainants to the greatest extent possible. In rare instances, the OIG may disclose your identity if such disclosure becomes unavoidable during the course of its work. The OIG will attempt to contact you before releasing your identity. Please provide personal contact information to help the OIG comply with nondisclosure preferences.

Return to the Disclosure Options When Submitting a Complaint page for more options.

VA employees, VA contractors, and any other HIPAA-covered individuals or entities (e.g., private healthcare providers and insurance providers) should not submit personally identifiable information, protected health information (PHI), or other VA-sensitive information (including patient names) via this web submission form. If submission of VA sensitive information or other PHI is required, please contact the VA OIG Hotline at 1-800-488-8244 to determine how to submit it. Additional information is available on the Hotline FAQ page.

Contact Information

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First Name*

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Last Name*

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Title

Address

City

State

Zip Code

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Telephone Number*

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Email Address*

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Complaint

VA Office or Facility Involved

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Alleged legal or policy violation(s) or other misconduct

Alleged legal or policy violations exceeds maximum number of characters.

Effect of the wrongdoing, such as dollars lost, delay produced, etc.

Effect of Wrongdoing exceeds maximum number of characters.

Names of Wrongdoers

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Names of Victims

Date(s) when the event(s) occurred

Dates of event exceeds maximum number of characters.

Names of witnesses

Names of Witnesses exceeds maximum number of characters.

Has this allegation been previously reviewed?

If yes, please provide the dates and who did the review

Previously Reviewed comments exceeds maximum number of characters.

Have you contacted the VA OIG about this issue before?

If yes, please provide date contact was made and to whom

Previous Contact comments exceeds maximum number of characters.

Additional Comments

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Attachments

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Sensitive Records

VA Employees should not send VA medical records or similar VA sensitive records via this portal.

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I am providing my name but request that the VA OIG not disclose my name outside the VA OIG. There may, however, be instances in which, during the course of an OIG investigation, an individual’s identity becomes discernable (e.g., when a very limited number of people are positioned to have information about the particular problem reported). The OIG will protect the identity of complainants to the greatest extent possible. In rare instances, the OIG may disclose your identity if such disclosure becomes unavoidable during the course of its work. The OIG will attempt to contact the complainant before releasing his or her identity. For more on protecting a complainant’s identity and release of information, see our Complainant and Identity Release Preference Page. You may also request an OIG Whistleblower Protection Coordinator to explain protections.

OIG Hotline Confidential Complaint Form

Attaching Files

Sensitive Records