Form
22C:
Questioning
Authority
Instructions
________________________________________________________________
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 F. 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.
Section 2.
General Information
________________________________________________________________
Before you
question authority, authority has a few questions
for you:
A. Full Name (First,
middle, last)
B. Social
Security Number (List all Social Security
Numbers you currently use. Attach extra sheets of
paper if necessary.)
C. Date Of
Birth (MM/DD/YYYY. Provide all dates of your
birth - past, present and future)
D. Place Of
Birth (Include city, state, and city/state of
mind)
E. Preferred
Place Of Burial Or Cremation (Only for
persons checking ‘A’ in Section 1
above.)
F. Phone
Numbers At Which You Can Be Reached (Include
area codes, not that we don't already know them)
G. What Is Your
Precise Location Right Now? (Only for persons
checking ‘A’ in Section 1 above. Not
that we don't already know it.)
Section 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
Section 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
Section 5. Your
question for authority_(Write in the space
provided to the left. If you need additional
space, please submit a separate Form 22C.)
Section 6.
CERTIFICATION
I certify, to the
best of my knowledge, that 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 record confirmation of tracking
device placed on submitter of this Form 22C.)
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