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.
In accordance with those routine uses,
the FBI may disclose information from my complaint to appropriate
federal, state, local, tribal or international law enforcement and