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