# UNITED STATES DEPARTMENT OF JUSTICE Office of the Inspector General

## WARNINGS AND ASSURANCES TO EMPLOYEE REQUIRED
TO PROVIDE INFORMATION

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:<empty>

You have a duty to reply to the questions posed to you during this interview and agency disciplinary action, including dismissal, may be undertaken if you refuse to answer or fail to reply fully and truthfully.

Neither your answers nor any information or evidence gained by reason of your answers can be used against you in any criminal proceeding. However, if you knowingly and willfully provide false statements or information in your answers, you may be criminally prosecuted for that action. The answers you furnish and any information or evidence resulting from them may be used in the course of agency disciplinary proceedings.

## ACKNOWLEDGMENT

I have read and understand my rights and obligations as set forth above.

Signature of the Office of the Inspector General Special Agent:<empty>
Employee's Signature:<empty>

Name of the Office of the Inspector General Special Agent:<empty>
Employee's Name:<empty>

Signature of Witness:<empty>
Date and Time:<empty>

Name of Witness:<empty>
Place:<empty>

OIG Form III-226/3 (05/03/21), Warnings and Assurances to Employee Required to Provide Information

EFTA00025542