Fillable PS8165 Inspection Service Mail Fraud Report

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PS8165 Inspection Service Mail Fraud Report

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  • 100 check-boxes
  • 55 other fields

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See page 2 for privacy Act Statement
PS Form 8165, August 2019,
(Page 1 of 2)
Company Name First Name Last Name
Address
Address
City
State
Country
Cell Phone (Include Area Code) Work Phone (Include Area Code) Home Phone (Include Area Code) Email Address
Fax Phone (Include Area Code) Website Address
First Name
Last Name
City State Country
Cell Phone (Include Area Code) Work Phone (Include Area Code) Home Phone (Include Area Code) Email A ddress
Check one of the following: PLEASE RETAIN ANY ORIGINAL DOCUMENTS. IF NEEDED, YOU WILL BE CONTACTED.
U.S. Mail
Telephone __________________
Internet ISP __________________
Website __________________
Email _____________________
Other _____________________________________________________
On what date were you contacted? If by mail, do you have the envelope it was mailed in? Does the envelope have a permit number?
Yes
No
Check one of the following:
U.S. Mail
Telephone __________________
Internet ISP __________________
Website __________________ Email _____________________
Other
______________________________________________________
To what name and address did you mail your response? _________________________________________________________________________
What did you receive?
How did it differ from what you expected?
How much did the company ask you to pay? Do you have the item? How was it delivered?
U.S. Mail Private Courier
Yes
Yes
No
Other _____________________________
How did you pay? (check one)
Cash Postal Money Order (Provide Postal Money Order Number) _____________________________________________
Money Transfer Service (Provide Transfer Service Name & Number) _____________________________________________
Transfer Number _______________________________
Pay Pal
Debit Card/Credit Card
Check
Other Money Order
________________
Date of Last Payment
/ /
Have you contacted the company or person about the complaint? Yes
No
If yes, date of last contact If no, why?
Address Unavailable
Addressee Not at Address
Disconnected Telephone Unlisted Telephone Unanswered Telephone
Legitimate businesses appreciate feedback. Check the offer for the delivery time frame, usually six to eight weeks, then contact the company. Please wait two weeks after
contacting them before sending us this form. When a delivery time is not specified, a Federal Trade Commission rule mandates fulfillment within 30 days, unless you applied
for first-time credit with the company.
/ /
U.S. Postal Inspection Service
Mail Fraud Report
Subject of Complaint
Your Information
How Were You Contacted?
How Did You Respond to this Offer?
Did You Lose Money?
Does the envelope have a postage meter number?
Yes
No
ZIP+4
®
ZIP+4
®
/ /
Yes If so, how much (in U.S. dollars)?
No Yes If Yes,
In Person
™
Do you have a tracking number?
Postage Meter Number
Tracking Number
™
12–17
18–19
20–29
30–39
40–54
55–64
65 or
older
Age Range: Veteran Status:
Yes
No
Phone App
Permit City
Permit State
Permit Number
Virtual Currency
Other (explain)
dd mmm yyyy
dd mmm yyyy
dd mmm yyyy
PS Form 8165, August 2019,
(Page 2 of 2)
Thank you for completing this form. Please mail to the address below all copies (not originals) of bills, receipts, advertisements, canceled checks (front and
back), or correspondence related to your report. The U.S. Postal Inspection Service is a federal law enforcement agency, and Postal Inspectors gather
facts and evidence to determine whether a violation has occurred under the Mail Fraud or False Representation Statutes. While we can’t guarantee you will
recover money lost to fraud, your information can help alert Inspectors about new fraud schemes and prevent others from being victimized. Postal Inspectors
base mail fraud investigations on the number, substance, and pattern of complaints received from the public; therefore, we ask you to keep all original
documents relating to your complaint, including the solicitation, any mailing envelopes, and canceled checks. Under our Consumer Protection Program,
Postal Inspectors may contact individuals or businesses on your behalf to request that complaints be resolved. We will contact you if more information is
needed. Postal Inspectors caution that, once you have been targeted in a fraud scheme, your name may be passed along to other con artists, so beware
of future solicitations. If you know of others who believe they were victimized by fraud, we recommend they submit a Mail Fraud Report. Postal Inspectors
suggest that, before completing a business transaction, contact the Chamber of Commerce, Better Business Bureau, or county or state Ofce of Consumer
Affairs where the rm is located to get information on the company. Visit the Better Business Bureau at bbb.org, the state National Association of Attorneys
General at naag.org, and the Postal Inspection Service at postalinspectors.uspis.gov for more information on fraud involving use of the mail. Remember: If a
deal sounds too good to be true, it probably is!
Return this form to your postmaster, or mail to:
CRIMINAL INVESTIGATIONS SERVICE CENTER
ATTN: MAIL FRAUD
433 W HARRISON STREET, RM 3255
CHICAGO IL 60699-3255
Privacy Act Statement. Your information will be used to submit a mail fraud report and to support investigations of criminal (civil or administrative) matters.
Collection is authorized by 39 U.S.C. 401 and 404; and 18 U.S.C. 3061.
Supplying the information is voluntary, but if not provided, we may not be able to investigate your mail fraud complaint. We do not disclose your information
to third parties without your consent, except to act on your behalf or request, or as legally required. This includes the following limited circumstances: to a
congressional office on your behalf; to a U.S. Postal Service auditor; for law enforcement purposes, to labor organizations as required by applicable law; incident
to legal proceedings involving the Postal Service; to government agencies in connection with decisions as necessary; to agents or contractors when necessary
to fulfill a business function or provide products and services to customers; to the Equal Employment Opportunity Commission when requested in connection
with the investigation of a formal complaint; to the Merit Systems Protection Board or Office of Special Counsel for the purpose of litigation; to the public, news
media, trade associations, or organized groups to provide information of interest to the public; to a federal, state, local or foreign prison, probation, parole,
or pardon authority or to any other agency involved with the maintenance, transportation, or release of a person held in custody; and to a foreign country as
authorized by an international treaty, convention, or executive agreement or to the extent necessary to assist such country in apprehending or returning a fugitive
to its jurisdiction. For more information on our privacy policies visit www.usps.com/privacypolicy.
Find the general category below that describes your area of concern, and check the specific item. (Check one only.)
Advance Payment Fiduciary Medical Quackery
Credit Card (Perpetrated by person in position of Medical Cure
Credit Repair, Debt Consolidation trust, financial advisor, attorney, etc.)
Sexual Aid
Loans
Bribery, Kickbacks, Embezzlements
Weight Loss
Medical Services
Estate
Financial Planning
Chain Letter
Will Merchandise or Services
Failure to Pay
Charity Fraud
Harassment
Failure to Provide
(Merchandise ordered in your name
Internet Auction
Contest, Prize, or Sweepstakes
without your consent.)
Misrepresentation of Product or Service
Mortgage Fraud
Educational Fraud
Insurance
Foreclosure Rescue
Certification
Health Care-Related
Mortgage Modification
Degree
Life Insurance Relate
d
Reverse Mortgage
Property Insurance Related
Employment Personal
Distributorship, Multilevel Marketing
International Fraud
Dating Service
Overseas Job
False Divorce Decree
Postal Service Job
Mail Order Bride
Secret Shopper
Investment
Work at Home
Franchise
Real Estate
Gems, Coins, Precious Metals
Land Sales
False Bill or Notice
Securities, Stocks
Timeshare
Classified Ad
Vacation or Travel
Directory Solicitation
Collection Agency Notice
Lottery
Sexually Oriented Advertisement
Office Supplies
(You pay to play.
)
Subscription/Periodical
Domestic
Taxes
Foreign
Other ______________________
Additional Information
Provide any additional information you feel is important regarding this complaint in the space below:
Name and Signature Date
Additional Information
Type of Mail Fraud Complaint
Impostor
(e.g., IRS, Social Security,
grandchild, grandparent)
dd mmm yyyy
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PS8165 Inspection Service Mail Fraud Report

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Completed 9 September 2019

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