File Complaint
  • Who Is Filing the Complaint?
  • Complainant Information
  • Financial Transaction(s)
  • Information About The Subject(s)
  • Description of Incident
  • Other Information
  • Privacy & Signature
  • A red asterisk (*) indicates a required field.
  • All other fields are optional. Please provide all requested information if possible, but these fields may be
    left blank.
  • Do NOT not provide complainant Personally Identifiable Information (PII) such as Social Security
    numbers or dates of birth anywhere in this form.

Who is Filing this Complaint?

If you were the one affected by this incident, please indicate so below. In the event that you are completing this form on behalf of another individual or business,
please select NO and provide your contact information.

  • A red asterisk (*) indicates a required field.
  • All other fields are optional. Please provide all requested information if possible, but these fields may be
    left blank.
  • Do NOT not provide complainant Personally Identifiable Information (PII) such as Social Security
    numbers or dates of birth anywhere in this form.

Complainant Information

Please provide as much detail as possible related to the one affected by this incident. If you are reporting on behalf of a
business, please include any Points-of-Contact (POCs) at the business in the section below.

Business Information

If applicable provide points of contact (POCs) for this business.

  • A red asterisk (*) indicates a required field.
  • All other fields are optional. Please provide all requested information if possible, but these fields may be
    left blank.
  • Do NOT not provide complainant Personally Identifiable Information (PII) such as Social Security
    numbers or dates of birth anywhere in this form.

Financial Transaction(s)

For the transaction information below:

  • Provide the most recent transactions involved with this incident.
  • Specify all money amounts below in US Dollars (USD).
  • Originating account refers to where the funds were sent from; usually the Complainant's account.
  • Recipient account refers to where the funds were sent to; usually a Subject's account.
  • More information about the types of transactions can be found by clicking the help icon  next to the Transaction Type field.
  • A red asterisk (*) indicates a required field.
  • All other fields are optional. Please provide all requested information if possible, but these fields may be
    left blank.
  • Do NOT not provide complainant Personally Identifiable Information (PII) such as Social Security
    numbers or dates of birth anywhere in this form.

Information About The Subject(s)

Please complete one section for each subject that caused this incident. If you do not have all of the requested information, please provide as much as possible. If subject(s) are not known, proceed to the next section.

  • A red asterisk (*) indicates a required field.
  • All other fields are optional. Please provide all requested information if possible, but these fields may be
    left blank.
  • Do NOT not provide complainant Personally Identifiable Information (PII) such as Social Security
    numbers or dates of birth anywhere in this form.

Description of Incident

Law enforcement or regulatory agencies may desire copies of pertinent documents or other evidence
regarding your complaint. Originals should be retained for use by law enforcement agencies. It is not
necessary to provide your evidence here.

Other Information

  • A red asterisk (*) indicates a required field.
  • All other fields are optional. Please provide all requested information if possible, but these fields may be
    left blank.
  • Do NOT not provide complainant Personally Identifiable Information (PII) such as Social Security
    numbers or dates of birth anywhere in this form.

Privacy & Signature

Read the following statement below, and confirm your agreement by typing your full name below in the box provided:

The collection of information on this form is authorized by one or more of the following statutes: 18 U.S.C. § 1028 (false documents and identity theft); 1028A (aggravated identity theft); 18 U.S.C. § 1029 (credit card fraud); 18 U.S.C. § 1030 (computer fraud); 18 U.S.C. § 1343 (wire fraud); 18 U.S.C 2318B (counterfeit and illicit labels); 18 U.S.C. § 2319 (violation of intellectual property rights); 28 U.S.C. § 533 (FBI authorized to investigate violations of federal law for which it has primary investigative jurisdiction); and 28 U.S.C. § 534 (FBI authorized to collect and maintain identification, criminal information, crime, and other records).

The collection of this information is relevant and necessary to document and investigate complaints of Internet-related crime. Submission of the information requested is voluntary; however, your failure to supply requested information may impede or preclude the investigation of your complaint by law enforcement agencies.

The information collected is maintained in one or more of the following Privacy Act Systems of Records: the FBI Central Records System, Justice/FBI-002, notice of which was published in the Federal Register at 63 Fed. Reg. 8671 (Feb. 20, 1998); the FBI Data Warehouse System, DOJ/FBI-022, notice of which was published in the Federal Register at 77 Fed. Reg. 40631 (July 10, 2012). Descriptions of these systems may also be found at www.justice.gov/opcl/doj-systems-records#FBI. The information collected may be disclosed in accordance with the routine uses referenced in those notices or as otherwise permitted by law. For example, in accordance with those routine uses, in certain circumstances, the FBI may disclose information from your complaint to appropriate criminal, civil, or regulatory law enforcement authorities (whether federal, state, local, territorial, tribal, foreign, or international). Information also may be disclosed as a routine use to an organization or individual in both the public or private sector if deemed necessary to elicit information or cooperation from the recipient for use by the FBI in the performance of an authorized activity. "An example would be where the activities of an individual are disclosed to a member of the public in order to elicit his/her assistance in [FBI's] apprehension or detection efforts." 63 Fed. Reg. 8671, 8682 (February 20, 1998).

By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature. I affirm that the information I provided is true and accurate to the best of my knowledge. I understand that providing false information could make me subject to fine, imprisonment, or both. (Title 18, U.S.Code, Section 1001)

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