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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, section 533; Title 28, Code of Federal Regulations, section 0.85; and the Attorney General Guidelines for Domestic FBI Operations. The information requested will assist the FBI in identifying victims of a criminal conspiracy as alleged in U.S. v. Babich, et al., No. 16 CR 10463, now pending in the United States District Court for the District of Massachusetts. You do not have to provide the requested information; however, failure to do so may hinder the FBI in identifying you as a victim of the alleged conspiracy. 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 The information collected may be disclosed as authorized by law.