Fillable COMPLAINT ALLEGING FAILURE OF DEPARTMENT OF JUSTICE EMPLOYEE (Bureau of Alcohol, Tobacco, Firearms, and Explosives)

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COMPLAINT ALLEGING FAILURE OF DEPARTMENT OF JUSTICE EMPLOYEE (Bureau of Alcohol, Tobacco, Firearms, and Explosives)

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FOR OFFICE USE ONLY
DATE RECEIVED: _____________
CASE NUMBER: _______________
COMPLAINT
ALLEGING FAILURE OF DEPARTMENT OF JUSTICE EMPLOYEE TO PROVIDE RIGHTS
TO A CRIME VICTIM UNDER THE CRIME VICTIMS’ RIGHTS ACT OF 2004
Return signed form, including additional pages or documents, to:
ATF National Victim Witness Coordinator
Special Operations Branch
99 New York Ave., N.E.
Room 7-S-140
Washington, D.C. 20226
Phone: 202-648-8620
Toll Free: 1-800-800-3855
Fax: 202-648-9616�
This Complaint form is not designed for the correction of specific victims’ rights violations, but is instead to
request corrective or disciplinary action against Department of Justice employees who may have failed to
provide or have violated the rights of a crime victim under the Crime Victims’ Rights Act of 2004. A crime
victim includes any person who has been directly and proximately harmed as a result of the commission of
a Federal offense or an offense in the District of Columbia.
All complaints must be submitted within sixty (60) days of the victim’s knowledge of a violation by the
Department of Justice employee, but not more than one year after the actual violation. Receipt of
complaints will be acknowledged in writing.
The information provided herein will be used along with other information developed during the
investigation to resolve or otherwise determine the merits of this complaint. The information may be
furnished to designated officers and employees of agencies and departments of the Federal Government
in order to resolve or otherwise determine the merits of this complaint.
Please check the box that applies to the person filing this complaint.
Victim Attorney representing victim
Legal Guardian Other representative (describe) __________________________
Name, phone number and relationship to victim of person completing this form (if not the victim).
Is the victim represented by an attorney in this complaint? Yes No
If yes, please provide the attorney’s name and contact information. All future contacts with the victim
regarding this complaint will be made through the attorney.
Complaint Alleging Failure of DOJ Employee To Provide Rights To A Crime Victim Rev. 03/06
1. PERSONAL INFORMATION ABOUT THE VICTIM
First Name Middle Name Last Name
Title: Mr. ___ Mrs. ___ Ms. ___ Miss ___ Other ___
Street Address:
City: State: Country: Zip Code:
Home Telephone No: Work Telephone No: Cell Phone No:
Email Address:
2. INFORMATION ABOUT THE CRIMINAL CASE
The following section requests important information about the criminal investigation or case in which you
are a victim. Please provide as much information as you can.
Stage of the Criminal Justice Process - Select most recent event:
Investigation Arrest Arraignment Preliminary Hearing Guilty Plea Trial
Sentencing Parole Hearing Other ________________________________________
Defendant(s) Name(s):
Case Number: District Court: Judge:
3. INFORMATION ABOUT THE VICTIM’S COMPLAINT
What is the location and name of the office(s) or organization(s) of the Department of Justice that is/are
the subject of your complaint?
Is your complaint against a specific person in that office? Yes No
If yes, please identify the person(s) (include position or title, if known) who failed to provide the right(s)
about which you are complaining.
Page 2 of 5
Complaint Alleging Failure of DOJ Employee To Provide Rights To A Crime Victim Rev. 03/06
Which of the following rights afforded by the Crime Victims’ Rights Act of 2004, 18 U.S.C. § 3771, do you
feel you were denied? Please check all that apply.
The right to be reasonably protected from the accused.
The right to reasonable, accurate, and timely notice of any public court proceeding, or any parole
proceeding, involving the crime or of any release or escape of the accused.
The right not to be excluded from any such public court proceeding, unless the court, afer
receiving clear and convincing evidence, determines that testimony by the victim would be
materially altered if the victim heard other testimony at that proceeding.
The right to be reasonably heard at any public proceeding in the district court involving release,
plea, sentencing, or any parole proceeding.
The reasonable right to confer with the attorney for the Government in the case.
The right to full and timely restitution as provided by law.
The right to proceedings free from unreasonable delay.
The right to be treated with fairness and with respect for the victim’s dignity and privacy.
4. STATEMENT OF COMPLAINANT
Please provide as much detailed information about your complaint against the Department of Justice
employee(s) as possible, including the date(s) of the alleged violation(s), and an explanation of how the
violation(s) occurred. However, you should not discuss the facts of the criminal investigation or case in
which you are a victim. You may attach additional pages or documents to this complaint.
Page 3 of 5
Complaint Alleging Failure of DOJ Employee To Provide Rights To A Crime Victim Rev. 03/06
Page 4 of 5
Complaint Alleging Failure of DOJ Employee To Provide Rights To A Crime Victim Rev. 03/06
5. PRIOR NOTIFICATION TO THE DEPARTMENT OF JUSTICE
Although you are not required to do so, did you notify the Department of Justice employee, or any
employee of the office described above, of the alleged violation before filing this complaint?
Yes No
If yes, please describe your efforts to resolve this matter, including the date(s) that you notified the
Department of Justice employee or any employee of the office described above; the name, address and
telephone number of the person with whom you attempted to resolve this matter; and the actions taken by
the Department of Justice employee or office to resolve your complaint. You may attached additional
pages or documents to this complaint.
6. OTHER RELEVANT INFORMATION
Provide any other relevant information or event(s). You may attach additional pages or
documents to this complaint.
The information set forth herein is true and correct to the best of my knowledge.
Signature (Must be signed by Victim) Date
If the crime victim is under 18 years of age, incompetent, incapacitated, or deceased, this form must be
signed by the Legal Guardian of the crime victim or the representative of the crime victim’s estate, family
member, or any other person appointed by the court. Please check all that apply to the victim:
Under 18 years of age Incapacitated Incompetent Deceased
Signature Date
Page 5 of 5
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COMPLAINT ALLEGING FAILURE OF DEPARTMENT OF JUSTICE EMPLOYEE (Bureau of Alcohol, Tobacco, Firearms, and Explosives)

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Completed 7 August 2020

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