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Federal Bureau of Investigation Federal Bureau of Investigation
Home • FBI Victim Services Intake

FBI Victim Services Intake

Thank you for reaching out to the Federal Bureau of Investigation (FBI).

We strive to adhere to and uphold the United States Attorney General Guidelines for Victim and Witness Assistance, along with the FBI’s mission to protect the citizens of the United States. The FBI is legally mandated to identify victims of federal crimes it investigates, and victims may be eligible for certain services, restitution, and rights under federal and/or state law.

To achieve this mission, please fill out the below form with as much information as possible. Your information will be routed to the FBI Victim Specialist in the field office geographically assigned to your address. Please note that based on the responses provided, you may be asked to provide additional information to help direct you to the relevant Victim Specialist. All identities of victims will be kept confidential.

Contact Information:

Date of Birth
/ /  

Questionnaire

2. Are you requesting victim services or investigative case updates?



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


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

Date of Birth
/ /  

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