Privacy Act Statement We are collecting the information under the authority of the Inspector General Act of 1978, as amended, (5 U.S.C. Chapter 4), particularly sections 404, 406, 407 and 420, regarding complaints within the jurisdiction of the FDIC OIG. However, that law does not require us to collect this information from you. Although we have marked certain items on this form as mandatory, the decision to file or not to file is voluntary on your part. FDIC employees and contractor personnel should refer to FDIC Directive 12000.01, Cooperation with the Office of Inspector General, regarding their reporting responsibilities. The primary purpose for soliciting this information is to “conduct … audits and investigations relating to the programs and operations” of the FDIC, “prevent and detect fraud and abuse,” “make such investigations and reports relating to the administration of the programs and operations of the [FDIC] as are, in the judgment of the Inspector General, necessary or desirable,” and “investigate complaints or information … concerning the possible existence of an activity constituting a violation of law, rules, or regulations, or mismanagement, gross waste of funds, abuse of authority or a substantial and specific danger to the public health and safety.” 5 U.S.C. §§ 404(a)(1), (2); 406(a)(2); 407(a). Depending on the nature of the information you provide us, we may share that information with various entities inside or outside the FDIC. The entities outside of the FDIC with whom we may share your information and the purpose(s) for which we may share that information are listed in the "Routine Use" sections of the following Privacy Act Systems of Records Notices: FDIC - 010, Investigative Files of the Office of Inspector General FDIC - 034 Office of Inspector General Inquiry Records These Systems of Records Notices can be found at the FDIC Privacy page at www.fdic.gov/privacy. We believe that the information that we are seeking in the above form will assist us in responding to you. To the extent that you do not provide us with the sought-after information, the failure to provide the information may hamper our ability to adequately respond to you.