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Federal Bureau of Investigation Federal Bureau of Investigation
Home • Seeking Victim Information in Buddy Goins Investigation

Seeking Victim Information in Buddy Goins Investigation

Contact Information:

Date of Birth  
/ /  

Questionnaire

1. I am filing this form out on behalf of:


2. If filling out this form for a minor dependent(s), please provide the minor dependent’s information:

Date of Birth
/ /  
3. Did the minor have the opportunity to be left alone, for any amount of time, with Buddy Goins?



4. Have you noticed any behavioral changes with the minor?



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Privacy Act Statement

The FBI is authorized to collect the information on this form by one or more of the following provisions: Title 28, United States Code, sections 533 and 534; Title 28, Code of Federal Regulations, section 0.85; and the Attorney General Guidelines for Victim and Witness Assistance. The information requested will assist the FBI in providing you with assistance to which crime victims are entitled under federal law. You do not have to provide the requested information; however, failure to do so may hinder the FBI in providing you with crime victim assistance. The information collected on this form is protected by the Privacy Act of 1974, as amended, Title 5, United States Code section 552a, and is maintained in the FBI’s Central Records System, DOJ/FBI-002, a description of which was published in the Federal Register at 63 Fed. Reg. 8671 (Feb. 20, 1998) and which may be viewed at www.justice.gov/opcl/doj-systems-records#doj