Office of the Inspector General
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OIG Complaint Form
 
 Date: 5/16/2008

Note: Anonymous complaints are more difficult to investigate but will be accepted.
 
Your Contact Information
 
First Name:   Middle Initial: Last Name:  
Street: City:
State:   Zip Code:    
Daytime Phone:  
   ex: 502-564-8900 		Email:  
 
My complaint is against (select all that apply)

 
Occurrence Location
City: County:
Occurrence Date:  
(mm/dd/yyyy)                  		Time:  
    (hh:mm AM)
 
Briefly describe the subject and nature of your complaint
 
 
Please Provide names, address and contact information of others who may be aware of the above reported occurrence.
 
Access Code:
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