U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT: REPORT CRIMES..., June 20, 2016...3:42 p.m., SYLVIA LYDIA MORELOS, SYLVIA LYDIA MORELOS [(*GARCIA REAGAN)]

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OMB Control Number: 1653-0049

Expiration Date: 11/30/2017

U.S. Immigration and Customs Enforcement (ICE) investigates more than 400 violations of criminal law, ranging from 
child exploitation to transnational gangs. Use this form to report suspected criminal activity.

Be as specific and as detailed as possible. You are encouraged to provide any additional identifying details such as places of birth, 
countries of citizenship, and social security numbers in the below narrative text box. The detailed information you provide will assist
investigators as they look into reported violations.

We do not provide status updates for tip information provided. If you provide information, you can be assured that it will be promptly 
forwarded to the responsible office for follow up action as deemed appropriate.

Do NOT send the same information more than once, and do NOT file a duplicate report by calling the HSI Tip Line.

Although there is absolutely no guarantee that tip information provided will result in monetary payments, ICE has the discretion and 
statutory authorization to pay for information and/or evidence that is used in support of criminal investigations.

Anonymous tips may be reported on this form and may also be reported to ICE via the toll-free HSI Tip Line, (866) 347-2423
TTY for hearing impaired only: || TTY para personas con discapacidad auditiva solamente: (802) 872-6196

* = Required Fields

I. Your information

First name:

Last name:

Email:

example@example.com

Phone number:

Where are you reporting from?

 Inside the U.S.

 Outside of the U.S.

II. Suspected Violation

Please check all that apply *

 Benefit/Marriage Fraud

 Bulk Cash Smuggling/Financial Crimes

 Child Exploitation/Pornography

 Cyber Crimes

 Employment/Exploitation of Unlawful Workers

 F/M Student Violations, Including OPT

 Fugitive Criminal Alien

 Gang Related

 Human Rights Violators

 Human Smuggling

 Human Trafficking (Forced Labor/Slavery)

 Intellectual Property Rights

 Narcotics Smuggling

 Terrorism Related

 Trade Exportation Violation

 Trade Importation Violation

 Weapons Smuggling

 Other

Location of Criminal Activity (if known)

(line 1):

(line 2):

City:

State:- None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip code:

III. Violator Information

The complaint involves a *

 Business/Company

 Individual

 Both

Have you previously submitted this information to any law enforcement or government agency? *

 Yes

 No

Please provide a summary of the criminal activity (limit 2,500 characters). *

2500 characters remaining

Did you have additional businesses/individuals to report on? *

 Yes

 No

PRIVACY ACT NOTICE/PAPERWORK REDUCTION ACT NOTICE

Authority: 6 U.S.C. § 203; 8 U.S.C. § 1103; 8 U.S.C. § 1357; 8 U.S.C. § 1360; 19 U.S.C. § 1589a; 5 U.S.C. § 552a; 5 U.S.C. § 301; and 
44 U.S.C. § 3101 authorize ICE to collect your information requested in this web form. Please also see the privacy policy for ICE's public 
website available at ICE's Privacy Policy for additional information about the type of information that is collected about you when you 
visit this and other pages on the ICE.gov website.

Purpose(s): The information requested is being collected to initiate and/or support a law enforcement investigation. ICE may also use 
your information to contact you for additional details about your tip, or to arrange monetary payment, if applicable.

Routine Use(s): Your information and the information you provide in your tip regarding suspicious or suspected criminal activity and/or 
violation of law may be shared internally within to the Department of Homeland Security (DHS) for any appropriate law enforcement 
action. The information you provide may also be shared with other federal, state, local, tribal or foreign agencies in order to refer reports 
of suspicious activity, tips, potential violations of law and other relevant information to those agencies with appropriate jurisdiction, 
authorities, and/or need-to-know concerning the matter(s) you report. The information you provide may also be disclosed as generally 
permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended, pursuant to the routine uses published in the Department of 
Homeland Security system of records notice, DHS/ICE-007 Alien Criminal Response Information Management.

Disclosure: In order to submit a tip using this web form, the disclosure of your contact information in this web form is voluntary. Should 
you wish to submit an anonymous tip via phone, you may call the HSI Tip Line at (866) 347-2423.

Public Reporting Burden: U.S. Immigration and Customs Enforcement is collecting this information as a part of its agency mission under 
the Department of Homeland Security. The estimated average time to review the instructions, search existing data sources, gather and 
maintain the data needed and completing and reviewing this collection of information is 10 minutes (0.166 hours) per response. An 
agency may not conduct or sponsor, and a person is not required to respond to, an information collection unless it displays a currently 
valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, 
including suggestions for reducing this burden, to: Office of the Chief Information Officer, Forms Management Office, 801 I Street NW,  
Washington, DC 20536-5800, ATTN: PRA Officer. Do not return the completed form to this address.

WARNING REGARDING KNOWINGLY PROVIDING FALSE INFORMATION

The information I've provided on this form is correct to the best of my knowledge. I understand that providing false information could 
subject me to fine, imprisonment, or both. (Title 18, U.S.C. § 1001).