Privacy Act Information Release Statement
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1PRIVACY ACT INFORMATION RELEASE STATEMENT
For use of this form, see AR 20-1; the proponent agency is the Office of The Inspector General.
, authorize access or release of:
I ,
(Rank/Title, First MI Last Name)
Any inspector general information or records pertaining to me
Inspector general information or records pertaining to my request specifically for
to the following individual(s):
General release
(Rank/Title, First MI Last Name)
SIGNATURE
DATE
(YYYYMMDD)
APD LC v1.00ES
DA FORM 7433, APR 2009
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