# 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:
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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.

Any 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 any kind has been used against me.

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-226/2 (05/03/21) Non-Custodial/Employee

EFTA00025541