Please fill in the date (or approximate date) you filed
Who is your complaint about?
Who is your complaint about (Subject)?
What is your complaint about?
What is your complaint about?
Fill in the address and name of the facility.
Please address who, what, when, where, why and how.
Please provide the tracking number if you have it
Can the missing item be traced? If the missing item is a gift card, credit card, or debit card please provide all retailer information and information on the card usage, if any. If the missing item is a check, please provide all information regarding usage, if any.
(such as inside post office, collection box, apartment cluster box, office mail room, etc.)? Was it mailed over the counter? Do you have a receipt? Did you declare what the items were enclosed in the mail when you mailed it over the counter?
including any markings/stamps applied during transit. (If possible, please save packaging for possible collection by OIG investigators). If the mail piece was received, please provide the date. Have you discussed this with your letter carrier or any Postal personnel? Be advised, discussing this with anyone other than an OIG investigator may limit our ability to conduct a thorough investigation.
Are you aware of the medical restrictions placed on the subject? Have you witnessed the subject engage in activities which were inconsistent with medical restrictions or their stated physical limitations?
What are the usual times and places of these activities?
Are you aware of any travel by the subject: Does the subject have a second home or a vacation home? Are you in frequent contact with the subject?
Enter the characters shown in the image.


Privacy Act Statement: The collection of this information, which will be used principally for investigations or audits into fraud, waste, and abuse in connection with the programs and operations of the U.S. Postal Service (USPS), is authorized by 39 USC 404, 18 USC 3061, and 5 USC, App. 3. It may be disclosed to an appropriate government agency, domestic or foreign, for law enforcement purposes; if pertinent, in a legal proceeding to which the USPS is a party or has an interest; to a government agency in order to obtain information relevant to a USPS decision concerning employment, security clearances, contracts, licenses, grants, permits or other benefits; to a government agency upon its request when relevant to its decision concerning employment, security clearances, security or suitability investigations, contracts, licenses, grants or other benefits; to a congressional office at your request; to an expert, consultant, or other person under contract with the USPS to fulfill an agency function; to the Federal Records Center for storage; to the Office of Management and Budget for review of private relief legislation; to an independent certified public accountant during an official audit of USPS finances; to an investigator, administrative judge or complaints examiner appointed by the Equal Employment Opportunity Commission for investigation of a formal EEO complaint under 29 CFR 1614; to the Merit Systems Protection Board or Office of Special Counsel for proceedings or investigations involving personnel nvestigation, trial or hearing; to obtain the cooperation of a witness or informant, or to notify of the status of the case; to a party or their attorney to discuss settlement, plea bargaining or discovery proceedings; to an agency or individual concerned with maintenance, extradition or release of a person held in custody; to a foreign country pursuant to an international treaty, convention or executive agreement; to the public, news media, trade associations or organized groups, if it is of interest, on accomplishments of the Postal Service or its employees; to a foreign country when apprehending or returning a fugitive to a jurisdiction seeking return; to American Insurance Association Index System members if it relates to accidents or injuries. Completion of this form is voluntary; however, the Office of Inspector General may not be able to address your complaint if the information is not provided. The USPS customer privacy policy may be found at