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REPRISAL COMPLAINT LETTER
SAMPLE FORMAT

DATE
RANK/RATE FULL NAME
HOME ADDRESS
ORGANIZATION
HOME TELEPHONE
WORK TELEPHONE

DEFENSE HOTLINE
THE PENTAGON
WASHINGTON DC 20301-1900
 

Dear Sir or Ma'am:

Reference, complaint of reprisal.

In letter format the complainant must provide detailed answers to the following questions:

Did you make or prepare a communication protected by statute?(Refer to the appropriate information sheet for the definition of a "protected communication.)

To whom did you make the communication and when? (Be specific concerning the date, time, location, and to whom your protected communication was made.)

What information did you disclose to that official? (Be as specific as possible.)

Was an unfavorable personnel action taken or threatened, or was a favorable action withheld or threatened to be withheld following the protected communication? (Refer to the appropriate information sheet for the definition of a "personnel action.)

What was the location and organization where the personnel action occurred?
(Include name and position of the official who took, threatened, or withheld the personnel action.)

What was the date of the personnel action(s) and what date did you first become aware of the personnel action(s)? (In accordance with the statute, reprisal complaints must be lodged within 60 days of the date the complainant/victim first learned that the personnel action was taken in reprisal for them having made the protected communication.)

Did the official(s) responsible for taking, withholding, or threatening the personnel action know about the protected communication(s)?

How do you know that the official who took the personnel action was aware of your protected communication before he/she took the action against you?(Explain how you know this to be the case.)

If you had not made the protected communication, would the personnel action have been taken, withheld or threatened anyway?(Explain how you know this to be the case.)

What evidence do you have that the official took the adverse personnel action against you in reprisal because you made the protected communication(s)?

Enclosures (You may submit your complaint by mail to the above address, or via fax to (703) 604-8567). You will be notified in writing what action we will take in response to your complaint).

(Print this page by pressing the print icon on your internet browser. Use it as a guide in preparing your complaint letter).