See It, Report It - Complaint

Allegation Details - Part 2

Incident Start Date

Is this an ongoing incident?
Yes No

Incident End Date

When were you made aware of this problem?*

Incident Address*

Incident City*

Incident State*

Incident Zip Code*

Is the suspected wrong doing related to a contract?
Yes No

Contract Information

Contract Number

What did the person(s) do or fail to do that was wrong?

Contract PCO Information

First Name

Last Name

Job Title

Personnel Type

Place of Employment/Duty Station

Work Phone Number

Cell Phone Number

Email Address

Please provide information related to the contract (PoP, Active vs. Non-Active, etc.)*

Are there other witnesses?
Yes No

Please provide the witnesses contact information

First Name

Last Name

Job Title

Personnel Type

Place of Employment/Duty Station

Work Phone Number

Cell Phone Number

Email Address

Supporting Documentation

If you have supporting documentation that you wish to provide with this complaint form, please use the fields below to add your documents.

DO NOT send CLASSIFIED documents using this unclassified internet system. If you provide your contact information, MDA will arrange to obtain any classified materials from you.

Valid file types include: doc, docx, gif, jpg, pdf, png, ppt, pptx, txt, xls, xlsx

Do you have classified documents that support this complaint?
Yes No Both

Statement Accuracy and Identity Attestation

I certify that all of the statements made in this complaint are true, complete, and correct, to the best of my knowledge. I understand that a false statement or concealment of a material fact is a criminal offense (18 U.S.C. § 1001).*

I have provided my election concerning my identity in Part I of this form (Release of Identity, Non-Release of Identity, or Anonymous). If I did not elect to release my identity, I understand this will cause a delay in processing my complaint. I further understand that if I have elected either confidential or anonymous status, it may impact the ability of See it, Report it personnel to either conduct an inquiry, or to appropriately address my issue(s). I also understand that if I elect anonymity, (providing no contact information), I will be unable to receive notification when this matter is closed nor how to request releasable records related to an inquiry. (Note: If you are filing a complaint of Discrimination or Harassment based on an Equal Opportunity protected basis, you must identify yourself during complaint intake, but may request anonymity during the pre-complaint process.)*

I understand that if See It, Report It personnel determine the allegation(s) in my complaint cannot be investigated without disclosing my identity on a need-to-know-basis to organizations outside the MDA, my lack of permission to release my identity may prevent further action from being taken on my complaint. I further understand that even if I elect confidential status, my identity may be disclosed, if required by applicable legal authority, or See It, Report It personnel determine that such a disclosure is unavoidable during the course of an investigation. I further acknowledge, that under certain circumstances, my identity may become apparent even though my name was not disclosed during the investigation. (Note: If you are filing a complaint of Discrimination or Harassment based on an Equal Opportunity protected basis, you must identify yourself during the investigation process.)*

What kind of complaint are you submitting?*

Criminal Conduct and Affiliations

Discrimination and Harassment

Espionage and Foreign Dealings

Fraud, Waste or Abuse

Information Protection

Network Security

Personal Conduct

Physical Security (Actual or Perceived Threats to the Agency)

Terrorism (Foreign or Domestic) and Extremism

Privacy

Privacy Act Statement for Collecting Complaints

Do you want to submit this form anonymously?

Contact Information

Identify the person who committed the alleged wrong doing

Allegation Details - Part 1

Identify the person who committed the alleged wrong doing

Please provide the witnesses contact information

Allegation Details - Part 2

Contract Information

Contract PCO Information

Please provide the witnesses contact information

Other Actions you are Taking

Supporting Documentation

Statement Accuracy and Identity Attestation

CAPTCHA Verification