This form is provided, pursuant to Title CC Subsection 007 of the Federal Office of Authority, to persons wishing to question authority. The information collected in this form is used to determine the meaning and validity of your question(s) for authority. Follow the instructions provided in the form and answer all relevant questions. If you believe a question to be irrelevant, answer it anyway. If you are unsure whether a question is relevant, you may submit a separate Form 22C. If you have questions or complaints regarding this Form 22C, you may fill out an additional Form 22C and attach it to this form, or to the Form 22C you are submitting regarding the relevancy of a question in this Form 22C. Submit one Form 22C for each question you wish to ask authority. Note: Do NOT submit multiple Form 22C’s in the same envelope.
Answer the questions below carefully. Warning - a false or truthful statement on any part of this form may be grounds for criminal prosecution (Title CC Subsection 007).
Section 1. Questioning Authority ________________________________________________________________
Reasons for Questioning Authority
Depending on your reasons for filling out this form, it may or may not be appropriate for you to fill out this form. Please answer the questions below in order to determine whether you actually have a need to question authority.
Please check only one of the following.
I am questioning authority because:
A. [ ] I wish to contest the right of those in authority to make decisions and dictate policies that affect my life and/or the lives of others
B. [ ] I wish to know who’s in authority
C. [ ] I wish to be told by those in authority what it is I’m supposed to do
D. [ ] I do not wish to question authority
If you checked ‘D’, you do not need to proceed further.
If you checked ‘C’, please proceed to Section 2, Question 6. You will be contacted shortly.
If you checked ‘B’, you do not need to proceed further.
If you checked A. Please proceed to Sections 2, 3, 4 and 6, and answer all questions completely. You will be contacted within the next few nanoseconds.
Privacy Act Statement ________________________________________________________________
The Federal Office of Authority is authorized to collect the information requested below in accordance with Title CC Subsection 007. If you have questions regarding the authority of the Federal Office of Authority to collect this information, please fill out Form 22C.
Public Burden Statement ________________________________________________________________
Public burden reporting for this document is estimated to vary from 0 to infinitely many minutes with an average of 15 minutes per response, including time for reviewing instructions, searching and gathering needed data, and being strip searched. Send comments regarding the burden estimate or any other aspect of this document, including suggestions for reducing the burden, to the Federal Office of Authority. Use Form 22C: Questioning Authority.
2. General Information ________________________________________________________________
Before you question authority, authority has a few questions for you:
1. Full Name (First, middle, last)
2. Social Security Number (List all Social Security Numbers you currently use. Attach extra sheets of paper if necessary.)
3. Date Of Birth (MM/DD/YYYY. Provide all dates of your birth - past, present and future)
4. Place Of Birth (Include city, state, and city/state of mind)
5. Preferred Place Of Burial Or Cremation (Only for persons checking ‘A’ above.)
6. Phone Numbers At Which You Can Be Reached (Include area codes, not that we don't already know them)
7. What Is Your Precise Location Right Now? (Only for persons checking ‘A’ above. Not that we don't already know it.)
3. Questions About Your Question For Authority ________________________________________________________________
Please answer all questions truthfully.
a. Do you like causing trouble? [ ] YES [ ] NO
b. Do you have a criminal record? Are you sure? Have you checked since you started filling out this form? [ ] YES [ ] NO
c. Do you have an aversion to deep, searing pain? [ ] YES [ ] NO
d. Have you ever seen the film Marathon Man? [ ] YES [ ] NO
e. Have you ever seen people in nursing homes? Did you know that some of those people are the same age as you? [ ] YES [ ] NO
4. ADDITIONAL QUESTIONS _______________________________________________________________
a. What’s the most awful, terrifying thing you can imagine happening to you?
b. Why do you fantasize about young children?
c. Are you sure you don’t want to crumple up this form and throw it away right now, while there’s still time? [ ] YES [ ] NO
5. Your question for authority_(Write in the space provided to the left. If you need additional space, please submit a separate Form 22C.)
6. CERTIFICATION ____________________________________________________________
I certify that, to the best of my knowledge and belief, all information on and attached to this Form 22C is true, correct, complete, and made in good faith. I understand that a false or truthful answer to any question on any part of this declaration or its attachments may be grounds for penalties, up to and including full time employment administering Form 22C. I further understand and acknowledge that, whatever statements I may have made to the contrary in the past, authority is good, and I was just kidding. I do not really believe what I have written in this form, if what I have written in this form could reasonably be construed as criticizing authority and/or those in authority.
Applicant's Signature: ______________________________________
(Office Use Only: Please note confirmation of tracking device placed on submitter of this Form 22C.)