ransomware.ic3.gov
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2001:489a:3604::7c0
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Submitted URL: http://ransomware.ic3.gov/
Effective URL: https://ransomware.ic3.gov/
Submission: On November 09 via api from US — Scanned from DE
Effective URL: https://ransomware.ic3.gov/
Submission: On November 09 via api from US — Scanned from DE
Form analysis 2 forms found in the DOM
POST https://www.ic3.gov/Search/Results
<form action="https://www.ic3.gov/Search/Results" autocomplete="off" class="usa-search usa-search--small" role="search" method="post">
<label class="usa-sr-only" for="search-field">Search</label>
<input class="usa-input" id="search-field" type="search" name="term">
<button class="usa-button" type="submit">
<img src="https://www.ic3.gov/assets/img/usa-icons-bg/search--white.svg" class="usa-search__submit-icon" alt="Search">
</button>
</form>POST
<form id="IC3ComplaintForm" action="" method="post" novalidate="">
<a id="prompt" aria-controls="promptModal" data-open-modal="" role="button"></a>
<div class="modal-bootstrap-hidden">
<div data-placeholder-for="promptModal" aria-hidden="true" data-original-id="promptModal" data-original-class="usa-modal" data-original-aria-labelledby="promptModalHeading" data-original-aria-describedby="promptModalDescription"
data-original-data-force-action="" style="display: none;"></div>
</div>
<article id="step1" class="form-step" data-step-num="1" aria-hidden="false">
<fieldset class="usa-fieldset">
<legend class="text-semibold border-bottom font-sans-lg width-full usa-legend usa-label">Who is Filing this Complaint?</legend>
<p>If you were the one affected by this incident, please indicate so below. In the event that you are completing this form on behalf of another individual or business, please select NO and provide your contact information.</p>
<fieldset class="usa-fieldset is-victim">
<legend class="usa-legend usa-label"><abbr class="usa-hint--required" title="Required">*</abbr>Were you the one affected in this incident?</legend>
<div class="usa-radio">
<input aria-errormessage="IsVictim_error" class="usa-radio__input" id="IsVictim_yes" required="" type="radio" value="true" data-val="true" data-val-required="Please indicate if you are the Victim in this incident." name="IsVictim">
<label class="usa-radio__label" for="IsVictim_yes">Yes</label>
<input aria-errormessage="IsVictim_error" class="usa-radio__input" id="IsVictim_no" required="" type="radio" value="false" name="IsVictim">
<label class="usa-radio__label" for="IsVictim_no">No</label>
</div>
<div class="val-error" id="IsVictim_error"></div>
</fieldset>
</fieldset>
<fieldset id="contactInfo" class="noborder margin-y-3">
<legend class="text-semibold border-bottom font-sans-lg width-full usa-legend usa-label">Your Contact Information</legend>
<aside class="text-italic">If you are the one affected by this incident, the information below will be transferred to the Complainant section.</aside>
<fieldset class="noborder"><label class="usa-label inline" for="Complainant_Name"><abbr class="usa-hint--required" title="Required">*</abbr>Name:</label><input required="" data-field-type="Name" aria-errormessage="Complainant_Name_error"
class="usa-input inline" data-val="true" data-val-length="The Complainant Name must be no longer than 50 characters." data-val-length-max="50" data-val-required="Please provide your name." id="Complainant_Name" maxlength="50"
name="Complainant.Name" type="text" value="">
<div class="val-error" id="Complainant_Name_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Complainant_BusinessName">Business Name: </label><input data-field-type="Business" aria-errormessage="Complainant_BusinessName_error" class="usa-input inline" data-val="true"
data-val-length="The Complainant Business Name must be no longer than 50 characters." data-val-length-max="50" id="Complainant_BusinessName" maxlength="50" name="Complainant.BusinessName" type="text" value="">
<div class="val-error" id="Complainant_BusinessName_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Complainant_Phone"><abbr class="usa-hint--required" title="Required">*</abbr>Phone Number: </label><span class="usa-tooltip display-inline"><input required="" type="tel"
pattern="\d+" class="usa-input inline usa-tooltip__trigger" data-position="right" data-classes="display-inline" data-field-type="Phone" aria-errormessage="Complainant_Phone_error" data-val="true"
data-val-length="The Complainant Phone Number must be no longer than 50 digits." data-val-length-max="50" data-val-regex="The Complainant Phone Number must be digits only. (ex. 1112223333)" data-val-regex-pattern="\d+"
data-val-required="Please provide your phone number." id="Complainant_Phone" maxlength="50" name="Complainant.Phone" value="" aria-describedby="tooltip-361859" tabindex="0"><span class="usa-tooltip__body" id="tooltip-361859"
role="tooltip" aria-hidden="true">Numbers only (1112223333)</span></span>
<div class="val-error" id="Complainant_Phone_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Complainant_Email"><abbr class="usa-hint--required" title="Required">*</abbr>Email Address: </label><span class="usa-tooltip display-inline"><input required="" type="email"
class="usa-input inline usa-tooltip__trigger" data-position="right" data-classes="display-inline" data-field-type="Email" aria-errormessage="Complainant_Email_error" data-val="true"
data-val-emailaddress="Please provide a valid Email Address for the Complainant." data-val-length="The Complainant Email Address must be no longer than 50 digits." data-val-length-max="50"
data-val-required="Please provide your email address." id="Complainant_Email" maxlength="50" name="Complainant.Email" value="" aria-describedby="tooltip-425424" tabindex="0"><span class="usa-tooltip__body" id="tooltip-425424"
role="tooltip" aria-hidden="true">Example: jdoe@email.com</span></span>
<div class="val-error" id="Complainant_Email_error"></div>
</fieldset>
</fieldset>
<div class="step-buttons">
<div aria-hidden="true"> </div><button type="button" class="usa-button next">Next (step 2)</button>
</div>
</article>
<article id="step2" class="form-step display-none" data-step-num="2" aria-hidden="true">
<fieldset class="usa-fieldset">
<legend class="text-semibold border-bottom font-sans-lg width-full usa-legend usa-label">Complainant Information</legend>
<p>Please provide as much detail as possible related to the one affected by this incident. If you are reporting on behalf of a business, please include any Points-of-Contact (<abbr>POC</abbr>s) at the business in the section below.</p>
<fieldset class="noborder"><label class="usa-label inline" for="Victim_Name"><abbr class="usa-hint--required" title="Required">*</abbr>Name: </label><input required="" data-field-type="Name" aria-errormessage="Victim_Name_error"
class="usa-input inline" data-val="true" data-val-length="The Complainant Name must be no longer than 50 characters." data-val-length-max="50" data-val-required="Please provide a Complainant Name." id="Victim_Name" maxlength="50"
name="Victim.Name" type="text" value="">
<div class="val-error" id="Victim_Name_error"></div>
</fieldset>
<fieldset class="noborder" data-target="isMinor" data-target-value="Under20">
<label class="usa-label inline" for="Victim_AgeRange">Age: </label>
<select class="usa-select inline" aria-errormessage="ageRangeError" id="Victim_AgeRange" name="Victim.AgeRange">
<option value="">Please select one...</option>
<optgroup label="">
<option value="Under20">Under 20</option>
<option value="TwentyTo29">20 - 29</option>
<option value="ThirtyTo39">30 - 39</option>
<option value="Fortyto49">40 - 49</option>
<option value="Fiftyto59">50 - 59</option>
<option value="Over60">Over 60</option>
</optgroup>
</select>
<div class="val-error" id="ageRangeError"></div>
</fieldset>
<fieldset class="usa-fieldset fieldset-contingent" id="isMinor" disabled="">
<legend class="usa-legend usa-label"><abbr class="usa-hint--required" title="Required">*</abbr>Is the complainant 17 years old or younger?</legend>
<div class="usa-radio">
<input aria-errormessage="Victim_IsMinor_error" class="usa-radio__input" id="Victim_IsMinor_yes" required="" type="radio" value="true" data-val="true" data-val-required-when="Please specify if this Complainant is aged 17 or under."
data-val-required-when-allowempty="false" data-val-required-when-input="Victim.AgeRange" data-val-required-when-op="eq" data-val-required-when-target="Under20" name="Victim.IsMinor">
<label class="usa-radio__label" for="Victim_IsMinor_yes">Yes</label>
<input aria-errormessage="Victim_IsMinor_error" class="usa-radio__input" id="Victim_IsMinor_no" required="" type="radio" value="false" name="Victim.IsMinor">
<label class="usa-radio__label" for="Victim_IsMinor_no">No</label>
</div>
<div class="val-error" id="Victim_IsMinor_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Victim_Address1"><abbr class="usa-hint--required" title="Required">*</abbr>Address: </label><input required="" aria-errormessage="Victim_Address1_error" class="usa-input inline"
data-val="true" data-val-length="The Complainant Address must be no longer than 50 characters." data-val-length-max="50" data-val-required="Please provide an address for the Complainant." id="Victim_Address1" maxlength="50"
name="Victim.Address1" type="text" value="">
<div class="val-error" id="Victim_Address1_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Victim_Address2">Address (continued): </label><input aria-errormessage="Victim_Address2_error" class="usa-input inline" data-val="true"
data-val-length="The Complainant Address (cont.) must be no longer than 50 characters." data-val-length-max="50" id="Victim_Address2" maxlength="50" name="Victim.Address2" type="text" value="">
<div class="val-error" id="Victim_Address2_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Victim_Suite">Suite/Apt./Mail Stop: </label><input aria-errormessage="Victim_Suite_error" class="usa-input inline" data-val="true"
data-val-length="The Complainant Suite must be no longer than 50 characters." data-val-length-max="50" id="Victim_Suite" maxlength="50" name="Victim.Suite" type="text" value="">
<div class="val-error" id="Victim_Suite_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Victim_City"><abbr class="usa-hint--required" title="Required">*</abbr>City: </label><input required="" aria-errormessage="Victim_City_error" class="usa-input inline"
data-val="true" data-val-length="The Complainant City must be no longer than 50 characters." data-val-length-max="50" data-val-required="Please provide a city for the Complainant." id="Victim_City" maxlength="50" name="Victim.City"
type="text" value="">
<div class="val-error" id="Victim_City_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Victim_County">County: </label><input aria-errormessage="Victim_County_error" class="usa-input inline" data-val="true"
data-val-length="The Complainant County must be no longer than 50 characters." data-val-length-max="50" id="Victim_County" maxlength="50" name="Victim.County" type="text" value="">
<div class="val-error" id="Victim_County_error"></div>
</fieldset>
<fieldset class="noborder" data-target="victimState" data-target-value="USA">
<label class="usa-label inline" for="Victim_Country"><abbr title="required" class="usa-hint--required">*</abbr>Country: </label>
<select class="usa-select inline" required="" aria-errormessage="victimCountryError" data-val="true" data-val-required="Please select a country for the Complainant." id="Victim_Country" name="Victim.Country">
<option value="" selected="selected">Please select one...</option>
<optgroup label="">
<option value="USA">United States of America</option>
<option value="AFG">Afghanistan</option>
<option value="ALA">Åland Islands</option>
<option value="ALB">Albania</option>
<option value="DZA">Algeria</option>
<option value="AND">Andorra</option>
<option value="AGO">Angola</option>
<option value="AIA">Anguilla</option>
<option value="ATA">Antarctica</option>
<option value="ATG">Antigua and Barbuda</option>
<option value="ARG">Argentina</option>
<option value="ARM">Armenia</option>
<option value="ABW">Aruba</option>
<option value="AUS">Australia</option>
<option value="AUT">Austria</option>
<option value="AZE">Azerbaijan</option>
<option value="BHS">Bahamas</option>
<option value="BHR">Bahrain</option>
<option value="BGD">Bangladesh</option>
<option value="BRB">Barbados</option>
<option value="BLR">Belarus</option>
<option value="BEL">Belgium</option>
<option value="BLZ">Belize</option>
<option value="BEN">Benin</option>
<option value="BMU">Bermuda</option>
<option value="BTN">Bhutan</option>
<option value="BOL">Bolivia (Plurinational State of)</option>
<option value="BES">Bonaire, Sint Eustatius and Saba</option>
<option value="BIH">Bosnia and Herzegovina</option>
<option value="BWA">Botswana</option>
<option value="BVT">Bouvet Island</option>
<option value="BRA">Brazil</option>
<option value="IOT">British Indian Ocean Territory</option>
<option value="BRN">Brunei Darussalam</option>
<option value="BGR">Bulgaria</option>
<option value="BFA">Burkina Faso</option>
<option value="BDI">Burundi</option>
<option value="CPV">Cabo Verde</option>
<option value="KHM">Cambodia</option>
<option value="CMR">Cameroon</option>
<option value="CAN">Canada</option>
<option value="CYM">Cayman Islands</option>
<option value="CAF">Central African Republic</option>
<option value="TCD">Chad</option>
<option value="CHL">Chile</option>
<option value="CHN">China</option>
<option value="CXR">Christmas Island</option>
<option value="CCK">Cocos (Keeling) Islands</option>
<option value="COL">Colombia</option>
<option value="COM">Comoros</option>
<option value="COG">Congo</option>
<option value="COD">Congo (Democratic Republic of the)</option>
<option value="COK">Cook Islands</option>
<option value="CRI">Costa Rica</option>
<option value="CIV">Côte d'Ivoire</option>
<option value="HRV">Croatia</option>
<option value="CUB">Cuba</option>
<option value="CUW">Curaçao</option>
<option value="CYP">Cyprus</option>
<option value="CZE">Czech Republic</option>
<option value="DNK">Denmark</option>
<option value="DJI">Djibouti</option>
<option value="DMA">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="ECU">Ecuador</option>
<option value="EGY">Egypt</option>
<option value="SLV">El Salvador</option>
<option value="GNQ">Equatorial Guinea</option>
<option value="ERI">Eritrea</option>
<option value="EST">Estonia</option>
<option value="ETH">Ethiopia</option>
<option value="FLK">Falkland Islands (Malvinas)</option>
<option value="FRO">Faroe Islands</option>
<option value="FJI">Fiji</option>
<option value="FIN">Finland</option>
<option value="FRA">France</option>
<option value="GUF">French Guiana</option>
<option value="PYF">French Polynesia</option>
<option value="ATF">French Southern Territories</option>
<option value="GAB">Gabon</option>
<option value="GMB">Gambia</option>
<option value="GEO">Georgia</option>
<option value="DEU">Germany</option>
<option value="GHA">Ghana</option>
<option value="GIB">Gibraltar</option>
<option value="GRC">Greece</option>
<option value="GRL">Greenland</option>
<option value="GRD">Grenada</option>
<option value="GLP">Guadeloupe</option>
<option value="GTM">Guatemala</option>
<option value="GGY">Guernsey</option>
<option value="GIN">Guinea</option>
<option value="GNB">Guinea-Bissau</option>
<option value="GUY">Guyana</option>
<option value="HTI">Haiti</option>
<option value="HMD">Heard Island and McDonald Islands</option>
<option value="VAT">Holy See</option>
<option value="HND">Honduras</option>
<option value="HKG">Hong Kong</option>
<option value="HUN">Hungary</option>
<option value="ISL">Iceland</option>
<option value="IND">India</option>
<option value="IDN">Indonesia</option>
<option value="IRN">Iran (Islamic Republic of)</option>
<option value="IRQ">Iraq</option>
<option value="IRL">Ireland</option>
<option value="IMN">Isle of Man</option>
<option value="ISR">Israel</option>
<option value="ITA">Italy</option>
<option value="JAM">Jamaica</option>
<option value="JPN">Japan</option>
<option value="JEY">Jersey</option>
<option value="JOR">Jordan</option>
<option value="KAZ">Kazakhstan</option>
<option value="KEN">Kenya</option>
<option value="KIR">Kiribati</option>
<option value="PRK">Korea (Democratic People's Republic of)</option>
<option value="KOR">Korea (Republic of)</option>
<option value="KWT">Kuwait</option>
<option value="KGZ">Kyrgyzstan</option>
<option value="LAO">Lao People's Democratic Republic</option>
<option value="LVA">Latvia</option>
<option value="LBN">Lebanon</option>
<option value="LSO">Lesotho</option>
<option value="LBR">Liberia</option>
<option value="LBY">Libya</option>
<option value="LIE">Liechtenstein</option>
<option value="LTU">Lithuania</option>
<option value="LUX">Luxembourg</option>
<option value="MAC">Macao</option>
<option value="MDG">Madagascar</option>
<option value="MWI">Malawi</option>
<option value="MYS">Malaysia</option>
<option value="MDV">Maldives</option>
<option value="MLI">Mali</option>
<option value="MLT">Malta</option>
<option value="MHL">Marshall Islands</option>
<option value="MTQ">Martinique</option>
<option value="MRT">Mauritania</option>
<option value="MUS">Mauritius</option>
<option value="MYT">Mayotte</option>
<option value="MEX">Mexico</option>
<option value="FSM">Micronesia (Federated States of)</option>
<option value="MDA">Moldova (Republic of)</option>
<option value="MCO">Monaco</option>
<option value="MNG">Mongolia</option>
<option value="MNE">Montenegro</option>
<option value="MSR">Montserrat</option>
<option value="MAR">Morocco</option>
<option value="MOZ">Mozambique</option>
<option value="MMR">Myanmar</option>
<option value="NAM">Namibia</option>
<option value="NRU">Nauru</option>
<option value="NPL">Nepal</option>
<option value="NLD">Netherlands</option>
<option value="NCL">New Caledonia</option>
<option value="NZL">New Zealand</option>
<option value="NIC">Nicaragua</option>
<option value="NER">Niger</option>
<option value="NGA">Nigeria</option>
<option value="NIU">Niue</option>
<option value="NFK">Norfolk Island</option>
<option value="MKD">North Macedonia</option>
<option value="NOR">Norway</option>
<option value="OMN">Oman</option>
<option value="PAK">Pakistan</option>
<option value="PLW">Palau</option>
<option value="PSE">Palestinian Territory, Occupied</option>
<option value="PAN">Panama</option>
<option value="PNG">Papua New Guinea</option>
<option value="PRY">Paraguay</option>
<option value="PER">Peru</option>
<option value="PHL">Philippines</option>
<option value="PCN">Pitcairn</option>
<option value="POL">Poland</option>
<option value="PRT">Portugal</option>
<option value="QAT">Qatar</option>
<option value="REU">Réunion</option>
<option value="ROU">Romania</option>
<option value="RUS">Russian Federation</option>
<option value="RWA">Rwanda</option>
<option value="BLM">Saint Barthélemy</option>
<option value="SHN">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KNA">Saint Kitts and Nevis</option>
<option value="LCA">Saint Lucia</option>
<option value="MAF">Saint Martin (French part)</option>
<option value="SPM">Saint Pierre and Miquelon</option>
<option value="VCT">Saint Vincent and the Grenadines</option>
<option value="WSM">Samoa</option>
<option value="SMR">San Marino</option>
<option value="STP">Sao Tome and Principe</option>
<option value="SAU">Saudi Arabia</option>
<option value="SEN">Senegal</option>
<option value="SRB">Serbia</option>
<option value="SYC">Seychelles</option>
<option value="SLE">Sierra Leone</option>
<option value="SGP">Singapore</option>
<option value="SXM">Sint Maarten (Dutch part)</option>
<option value="SVK">Slovakia</option>
<option value="SVN">Slovenia</option>
<option value="SLB">Solomon Islands</option>
<option value="SOM">Somalia</option>
<option value="ZAF">South Africa</option>
<option value="SGS">South Georgia and the South Sandwich Islands</option>
<option value="SSD">South Sudan</option>
<option value="ESP">Spain</option>
<option value="LKA">Sri Lanka</option>
<option value="SDN">Sudan</option>
<option value="SUR">Suriname</option>
<option value="SJM">Svalbard and Jan Mayen</option>
<option value="SWZ">Swaziland</option>
<option value="SWE">Sweden</option>
<option value="CHE">Switzerland</option>
<option value="SYR">Syrian Arab Republic</option>
<option value="TWN">Taiwan</option>
<option value="TJK">Tajikistan</option>
<option value="TZA">Tanzania, United Republic of</option>
<option value="THA">Thailand</option>
<option value="TLS">Timor-Leste</option>
<option value="TGO">Togo</option>
<option value="TKL">Tokelau</option>
<option value="TON">Tonga</option>
<option value="TTO">Trinidad and Tobago</option>
<option value="TUN">Tunisia</option>
<option value="TUR">Turkey</option>
<option value="TKM">Turkmenistan</option>
<option value="TCA">Turks and Caicos Islands</option>
<option value="TUV">Tuvalu</option>
<option value="UGA">Uganda</option>
<option value="UKR">Ukraine</option>
<option value="ARE">United Arab Emirates</option>
<option value="GBR">United Kingdom</option>
<option value="USA">United States of America</option>
<option value="URY">Uruguay</option>
<option value="UZB">Uzbekistan</option>
<option value="VUT">Vanuatu</option>
<option value="VEN">Venezuela (Bolivarian Republic of)</option>
<option value="VNM">Viet Nam</option>
<option value="VGB">Virgin Islands (British)</option>
<option value="WLF">Wallis and Futuna</option>
<option value="ESH">Western Sahara</option>
<option value="YEM">Yemen</option>
<option value="ZMB">Zambia</option>
<option value="ZWE">Zimbabwe</option>
</optgroup>
</select>
<div class="val-error" id="victimCountryError"></div>
</fieldset>
<fieldset id="victimState" class="noborder fieldset-contingent" disabled="">
<label class="usa-label inline" for="Victim_State"><abbr title="required" class="usa-hint--required">*</abbr>State: </label>
<select required="" class="usa-select inline" aria-errormessage="victimStateError" data-val="true" data-val-required-when="The Complainant State field is required if the Complainant is in the United States of America."
data-val-required-when-allowempty="false" data-val-required-when-input="Victim.Country" data-val-required-when-op="eq" data-val-required-when-target="USA" id="Victim_State" name="Victim.State">
<option value="">Please select one...</option>
<optgroup label="">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</optgroup>
</select>
<div class="val-error" id="victimCountryError"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Victim_ZipCode"><abbr class="usa-hint--required" title="Required">*</abbr>Zip Code/Route: </label><input required="" aria-errormessage="Victim_ZipCode_error"
class="usa-input inline" data-val="true" data-val-length="The Complainant Zip Code must be no longer than 20 characters." data-val-length-max="20" data-val-required="Please provide a ZIP Code or Route for the Complainant."
id="Victim_ZipCode" maxlength="20" name="Victim.ZipCode" type="text" value="">
<div class="val-error" id="Victim_ZipCode_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Victim_Phone"><abbr class="usa-hint--required" title="Required">*</abbr>Phone Number: </label><span class="usa-tooltip display-inline"><input required="" type="tel" pattern="\d+"
class="usa-input inline usa-tooltip__trigger" data-position="right" data-classes="display-inline" data-field-type="Phone" aria-errormessage="Victim_Phone_error" data-val="true"
data-val-length="The Complainant Phone Number must be no longer than 50 digits." data-val-length-max="50" data-val-regex="The Complainant Phone Number must be digits only. (ex. 1112223333)" data-val-regex-pattern="\d+"
data-val-required="Please provide a Phone Number for the Complainant." id="Victim_Phone" maxlength="50" name="Victim.Phone" value="" aria-describedby="tooltip-223751" tabindex="0"><span class="usa-tooltip__body" id="tooltip-223751"
role="tooltip" aria-hidden="true">Numbers only (1112223333)</span></span>
<div class="val-error" id="Victim_Phone_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Victim_Email"><abbr class="usa-hint--required" title="Required">*</abbr>Email Address: </label><span class="usa-tooltip display-inline"><input required="" type="email"
class="usa-input inline usa-tooltip__trigger" data-position="right" data-classes="display-inline" data-field-type="Email" aria-errormessage="Victim_Email_error" data-val="true"
data-val-emailaddress="Please provide a valid Email Address for the Complainant." data-val-length="The Complainant Email Address must be no longer than 50 characters." data-val-length-max="50"
data-val-required="Please provide an Email Address for the Complainant." id="Victim_Email" maxlength="50" name="Victim.Email" value="" aria-describedby="tooltip-248759" tabindex="0"><span class="usa-tooltip__body" id="tooltip-248759"
role="tooltip" aria-hidden="true">Example: jdoe@email.com</span></span>
<div class="val-error" id="Victim_Email_error"></div>
</fieldset>
</fieldset>
<fieldset class="usa-fieldset margin-y-3">
<legend class="text-semibold border-bottom font-sans-lg width-full usa-legend usa-label">Business Information</legend>
<fieldset class="usa-fieldset" data-target="businessInfo">
<legend class="usa-legend usa-label">Is this on behalf of a business that was targeted by a Cyber incident?</legend>
<div class="usa-radio">
<input aria-errormessage="Victim_IsBusiness_error" class="usa-radio__input" id="Victim_IsBusiness_yes" type="radio" value="true" name="Victim.IsBusiness">
<label class="usa-radio__label" for="Victim_IsBusiness_yes">Yes</label>
<input aria-errormessage="Victim_IsBusiness_error" class="usa-radio__input" id="Victim_IsBusiness_no" type="radio" value="false" name="Victim.IsBusiness">
<label class="usa-radio__label" for="Victim_IsBusiness_no">No</label>
</div>
<div class="val-error" id="Victim_IsBusiness_error"></div>
</fieldset>
<fieldset id="businessInfo" class="noborder fieldset-contingent" disabled="">
<fieldset class="noborder"><label class="usa-label inline" for="Victim_BusinessName"><abbr class="usa-hint--required" title="Required">*</abbr>Business Name: </label><input required="" data-field-type="Business"
aria-errormessage="Victim_BusinessName_error" class="usa-input inline" data-val="true" data-val-length="The Complainant Business Name must be no longer than 50 characters." data-val-length-max="50"
data-val-required-if="Please provide a Complainant Business Name if you are filing on behalf of a business." data-val-required-if-allowempty="false" data-val-required-if-input="Victim.IsBusiness" id="Victim_BusinessName" maxlength="50"
name="Victim.BusinessName" type="text" value="">
<div class="val-error" id="Victim_BusinessName_error"></div>
</fieldset>
<fieldset class="usa-fieldset">
<legend class="usa-legend usa-label"><abbr class="usa-hint--required" title="Required">*</abbr>Is the incident currently impacting business operations?</legend>
<div class="usa-radio">
<input aria-errormessage="Victim_BusinessImpacted_error" class="usa-radio__input" id="Victim_BusinessImpacted_yes" required="" type="radio" value="true" data-val="true"
data-val-required-if="Specify if business has been impacted if you are filing on behalf of a business." data-val-required-if-allowempty="false" data-val-required-if-input="Victim.IsBusiness" name="Victim.BusinessImpacted">
<label class="usa-radio__label" for="Victim_BusinessImpacted_yes">Yes</label>
<input aria-errormessage="Victim_BusinessImpacted_error" class="usa-radio__input" id="Victim_BusinessImpacted_no" required="" type="radio" value="false" name="Victim.BusinessImpacted">
<label class="usa-radio__label" for="Victim_BusinessImpacted_no">No</label>
</div>
<div class="val-error" id="Victim_BusinessImpacted_error"></div>
</fieldset>
<aside class="text-italic margin-top-2">If applicable, provide points of contact (<abbr>POC</abbr>s) for this business.</aside>
<fieldset class="noborder"><label class="usa-label inline" for="Victim_ItPoc">Business IT POC: </label><span class="usa-tooltip display-inline"><input class="usa-input inline usa-tooltip__trigger" data-position="right"
data-classes="display-inline" aria-errormessage="Victim_ItPoc_error" data-val="true" data-val-length="The Complainant Business IT POC must be no longer than 150 characters." data-val-length-max="150" id="Victim_ItPoc" maxlength="150"
name="Victim.ItPoc" type="text" value="" aria-describedby="tooltip-416244" tabindex="0"><span class="usa-tooltip__body" id="tooltip-416244" role="tooltip" aria-hidden="true">Include Name, Email, Phone number, etc.</span></span>
<div class="val-error" id="Victim_ItPoc_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Victim_OtherPoc">Other Business POC: </label><span class="usa-tooltip display-inline"><input class="usa-input inline usa-tooltip__trigger" data-position="right"
data-classes="display-inline" aria-errormessage="Victim_OtherPoc_error" data-val="true" data-val-length="The Complainant Business POC must be no longer than 150 characters." data-val-length-max="150" id="Victim_OtherPoc" maxlength="150"
name="Victim.OtherPoc" type="text" value="" aria-describedby="tooltip-183894" tabindex="0"><span class="usa-tooltip__body" id="tooltip-183894" role="tooltip" aria-hidden="true">Include Name, Email, Phone number, etc.</span></span>
<div class="val-error" id="Victim_OtherPoc_error"></div>
</fieldset>
<fieldset class="noborder" id="inf">
<label class="usa-label" for="Victim_Sector">If your business or organization is defined as a critical infrastructure entity, select the sector below:</label>
<select class="usa-select" aria-errormessage="sectorError" id="Victim_Sector" name="Victim.Sector">
<option value="">None/Unsure</option>
<option value="0">Chemical</option>
<option value="1">Commercial Facilities</option>
<option value="2">Communications</option>
<option value="3">Critical Manufacturing</option>
<option value="4">Dams</option>
<option value="5">Defense Industrial Base</option>
<option value="6">Emergency Services</option>
<option value="7">Energy</option>
<option value="8">Financial Services</option>
<option value="9">Food and Agriculture</option>
<option value="10">Government Facilities</option>
<option value="11">Healthcare and Public Health</option>
<option value="12">Information Technology</option>
<option value="13">Nuclear Reactors, Materials, & Waste</option>
<option value="14">Transportation Systems</option>
<option value="15">Water & Wastewater Systems</option>
</select>
<div class="val-error" id="sectorError"></div>
</fieldset>
<fieldset class="noborder fieldset-contingent" id="infSub" disabled="">
<label class="usa-label" for="Victim_Subsector">If known or applicable, please select the critical infrastructure subsector:</label>
<select class="usa-select" aria-errormessage="subsectorError" id="Victim_Subsector" name="Victim.Subsector">
<option value="0" selected="selected">None/Unsure</option>
</select>
<div class="val-error" id="subsectorError"></div>
</fieldset>
</fieldset>
</fieldset>
<div class="step-buttons"><button type="button" class="usa-button prev">Previous (step 1)</button>
<div aria-hidden="true"> </div><button type="button" class="usa-button next">Next (step 3)</button>
</div>
</article>
<article id="step3" class="form-step display-none" data-step-num="3" aria-hidden="true">
<fieldset class="usa-fieldset">
<legend class="text-semibold border-bottom font-sans-lg width-full usa-legend usa-label">Financial Transaction(s)</legend>
<fieldset class="usa-fieldset" data-target="reportedLoss">
<legend class="usa-legend usa-label"><abbr class="usa-hint--required" title="Required">*</abbr>Did you send or lose money in the incident?</legend>
<div class="usa-radio">
<input aria-errormessage="MoneySent_error" class="usa-radio__input" id="MoneySent_yes" required="" type="radio" value="true" data-val="true" data-val-required="Please indicate if money was lost in this incident." name="MoneySent">
<label class="usa-radio__label" for="MoneySent_yes">Yes</label>
<input aria-errormessage="MoneySent_error" class="usa-radio__input" id="MoneySent_no" required="" type="radio" value="false" name="MoneySent">
<label class="usa-radio__label" for="MoneySent_no">No</label>
</div>
<div class="val-error" id="MoneySent_error"></div>
</fieldset>
<fieldset id="reportedLoss" class="fieldset-contingent noborder" disabled="">
<label class="usa-label" for="ReportedLoss"><abbr class="usa-hint--required" title="Required">*</abbr>What was your total loss amount?</label>
<input required="" type="number" min="0" max="9999999999.99" step="0.01" aria-errormessage="ReportedLossError" class="usa-input" data-val="true" data-val-number="The field ReportedLoss must be a number."
data-val-range="Please enter a positive loss amount less than $9,999,999,999.99." data-val-range-max="9999999999.99" data-val-range-min="0" data-val-required-if="Please specify the total amount of money lost."
data-val-required-if-allowempty="false" data-val-required-if-input="MoneySent" id="ReportedLoss" name="ReportedLoss" value=""><input name="__Invariant" type="hidden" value="ReportedLoss">
<div class="val-error" id="ReportedLossError"></div>
</fieldset>
</fieldset>
<div class="usa-alert usa-alert--warning usa-alert--no-icon">
<div class="usa-alert__body">
<p class="usa-alert__heading text-bold" role="heading" aria-level="7">For the transaction information below:</p>
<ul class="usa-alert__text margin-y-0">
<li>Provide the most recent transactions involved with this incident.</li>
<li>Specify all money amounts below in US Dollars (<abbr>USD</abbr>).</li>
<li>Originating account refers to where the funds were sent from; usually the Complainant's account.</li>
<li>Recipient account refers to where the funds were sent to; usually a Subject's account.</li>
<li>More information about the types of transactions can be found by clicking the help icon <span aria-hidden="true">(<svg class="usa-icon" aria-hidden="true" focusable="false" role="img">
<use href="/img/sprite.svg#help"></use>
</svg>)</span> next to the Transaction Type field.</li>
</ul>
</div>
</div>
<div data-placeholder-for="tTypeDef" aria-hidden="true" data-original-class="usa-modal usa-modal--lg" data-original-id="tTypeDef" data-original-aria-labelledby="tTypeDefHeading" data-original-aria-describedby="tTypeDefDescription"
style="display: none;"></div>
<a class="display-none" href="#tTypeDef" aria-controls="tTypeDef" id="tTypeDefOpen" data-open-modal="" role="button"></a>
<div data-placeholder-for="tRoutingNumDef" aria-hidden="true" data-original-class="usa-modal usa-modal--lg" data-original-id="tRoutingNumDef" data-original-aria-labelledby="tRoutingNumDefHeading"
data-original-aria-describedby="tRoutingNumDefDescription" style="display: none;"></div>
<a class="display-none" href="#tRoutingNumDef" aria-controls="tRoutingNumDef" id="tRoutingNumDefOpen" data-open-modal="" role="button"></a>
<div data-placeholder-for="tSwiftDef" aria-hidden="true" data-original-class="usa-modal usa-modal--lg" data-original-id="tSwiftDef" data-original-aria-labelledby="tSwiftDefHeading" data-original-aria-describedby="tSwiftDefDescription"
style="display: none;"></div>
<a class="display-none" href="#tSwiftDef" aria-controls="tSwiftDef" id="tSwiftDefOpen" data-open-modal="" role="button"></a>
<div data-placeholder-for="p2pAccountIdDef" aria-hidden="true" data-original-class="usa-modal usa-modal--lg" data-original-id="p2pAccountIdDef" data-original-aria-labelledby="p2pAccountIdDefHeading"
data-original-aria-describedby="p2pAccountIdDefDescription" style="display: none;"></div>
<a class="display-none" href="#p2pAccountIdDef" aria-controls="p2pAccountIdDef" id="p2pAccountIdDefOpen" data-open-modal="" role="button"></a>
<div data-placeholder-for="cryptoCurrencyTypeDef" aria-hidden="true" data-original-class="usa-modal usa-modal--lg" data-original-id="cryptoCurrencyTypeDef" data-original-aria-labelledby="cryptoCurrencyTypeDefHeading"
data-original-aria-describedby="cryptoCurrencyTypeDefDescription" style="display: none;"></div>
<a class="display-none" href="#cryptoCurrencyTypeDef" aria-controls="cryptoCurrencyTypeDef" id="cryptoCurrencyTypeDefOpen" data-open-modal="" role="button"></a>
<div data-placeholder-for="txnHashDef" aria-hidden="true" data-original-class="usa-modal usa-modal--lg" data-original-id="txnHashDef" data-original-aria-labelledby="txnHashDefHeading" data-original-aria-describedby="txnHashDefDescription"
style="display: none;"></div>
<a class="display-none" href="#txnHashDef" aria-controls="txnHashDef" id="txnHashDefOpen" data-open-modal="" role="button"></a>
<div data-placeholder-for="cryptoCurrencyAtmDef" aria-hidden="true" data-original-class="usa-modal usa-modal--lg" data-original-id="cryptoCurrencyAtmDef" data-original-aria-labelledby="cryptoCurrencyAtmDefHeading"
data-original-aria-describedby="cryptoCurrencyAtmDefDescription" style="display: none;"></div>
<a class="display-none" href="#cryptoCurrencyAtmDef" aria-controls="cryptoCurrencyAtmDef" id="cryptoCurrencyAtmDefOpen" data-open-modal="" role="button"></a>
<div data-placeholder-for="cryptoCurrencyAtmAddressDef" aria-hidden="true" data-original-class="usa-modal usa-modal--lg" data-original-id="cryptoCurrencyAtmAddressDef" data-original-aria-labelledby="cryptoCurrencyAtmAddressDefHeading"
data-original-aria-describedby="cryptoCurrencyAtmAddressDefDescription" style="display: none;"></div>
<a class="display-none" href="#cryptoCurrencyAtmAddressDef" aria-controls="cryptoCurrencyAtmAddressDef" id="cryptoCurrencyAtmAddressDefOpen" data-open-modal="" role="button"></a>
<div data-placeholder-for="cryptoCurrencyOrigAddressDef" aria-hidden="true" data-original-class="usa-modal usa-modal--lg" data-original-id="cryptoCurrencyOrigAddressDef" data-original-aria-labelledby="cryptoCurrencyOrigAddressDefHeading"
data-original-aria-describedby="cryptoCurrencyOrigAddressDefDescription" style="display: none;"></div>
<a class="display-none" href="#cryptoCurrencyOrigAddressDef" aria-controls="cryptoCurrencyOrigAddressDef" id="cryptoCurrencyOrigAddressDefOpen" data-open-modal="" role="button"></a>
<div data-placeholder-for="cryptoCurrencyRecipAddressDef" aria-hidden="true" data-original-class="usa-modal usa-modal--lg" data-original-id="cryptoCurrencyRecipAddressDef" data-original-aria-labelledby="cryptoCurrencyRecipAddressDefHeading"
data-original-aria-describedby="cryptoCurrencyRecipAddressDefDescription" style="display: none;"></div>
<a class="display-none" href="#cryptoCurrencyRecipAddressDef" aria-controls="cryptoCurrencyRecipAddressDef" id="cryptoCurrencyRecipAddressDefOpen" data-open-modal="" role="button"></a>
<div data-placeholder-for="giftCardTypeDef" aria-hidden="true" data-original-class="usa-modal usa-modal--lg" data-original-id="giftCardTypeDef" data-original-aria-labelledby="giftCardTypeDefHeading"
data-original-aria-describedby="giftCardTypeDefDescription" style="display: none;"></div>
<a class="display-none" href="#giftCardTypeDef" aria-controls="giftCardTypeDef" id="giftCardTypeDefOpen" data-open-modal="" role="button"></a>
<div class="transactions usa-accordion usa-accordion--bordered usa-accordion--multiselectable margin-y-3" data-allow-multiple="">
<div data-index="1">
<div class="usa-accordion__heading">
<button type="button" class="usa-accordion__button" aria-controls="transaction0" aria-expanded="true">
<div>Transaction #1</div>
</button>
</div>
<div class="usa-accordion__content" id="transaction0">
<button class="float-right usa-button" type="submit" name="Transaction" formaction="RemoveTransaction#step3" data-ordinal="-9999" value="0">Remove Transaction</button>
<fieldset class="noborder">
<label class="usa-label inline margin-right-05" for="Transactions_0__TransactionType">Transaction Type:
<a class="ic3-open-modal" href="#" aria-controls="tTypeDef" aria-label="Get definitions of transaction types" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a></label>
<select class="usa-select inline transaction-type" data-ordinal="0.01" aria-errormessage="Transactions_0__TransactionType_error" id="Transactions_0__TransactionType" name="Transactions[0].TransactionType">
<option value="">Please select one...</option>
<optgroup label="">
<option value="0">Cash</option>
<option value="1">Check/Cashier's Check</option>
<option value="6">Cryptocurrency/Crypto ATM</option>
<option value="2">Debit Card/Credit Card</option>
<option value="3">Money Order</option>
<option value="8">Other</option>
<option value="7">Peer-to-peer Transfer</option>
<option value="5">Prepaid Card/Gift Card</option>
<option value="4">Wire Transfer</option>
</optgroup>
</select>
<div class="val-error" id="Transactions_0__TransactionType_error"></div>
</fieldset>
<hr class="opacity-0" data-ordinal="1">
<hr class="opacity-0" data-ordinal="1000">
<details class="transaction--disabled-fields margin-top-1" data-ordinal="99999">
<summary>Non-applicable fields (click to view)</summary>
<fieldset class="noborder t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__OtherType"><abbr class="usa-hint--required" title="Required">*</abbr>If other, please specify: </label><input
data-ordinal="0.02" required="" aria-errormessage="Transactions_0__OtherType_error" class="usa-input inline" data-val="true" data-val-length="The Other Transaction Type for transaction #1 must be no longer than 50 characters."
data-val-length-max="50" data-val-required-when="The Other Type field for transaction #1 must have a value if the Transaction Type is 'Other'." data-val-required-when-allowempty="false"
data-val-required-when-input="Transactions[0].TransactionType" data-val-required-when-op="eq" data-val-required-when-target="8" id="Transactions_0__OtherType" maxlength="50" name="Transactions[0].OtherType" type="text" value="">
<div class="val-error" id="Transactions_0__OtherType_error"></div>
</fieldset>
<fieldset class="usa-fieldset tall fieldset-contingent" data-ordinal="0.03" disabled="">
<legend class="usa-legend usa-label"><abbr class="usa-hint--required" title="Required">*</abbr>Was the money sent or lost?</legend>
<div class="usa-radio">
<input aria-errormessage="Transactions_0__WasSent_error" class="usa-radio__input" id="Transactions_0__WasSent_yes" required="" type="radio" value="true" data-val="true"
data-val-required-when="Please specify if the money was sent for transaction #1." data-val-required-when-allowempty="false" data-val-required-when-input="Transactions[0].TransactionType" data-val-required-when-op="ne"
data-val-required-when-target="" name="Transactions[0].WasSent">
<label class="usa-radio__label" for="Transactions_0__WasSent_yes">Yes</label>
<input aria-errormessage="Transactions_0__WasSent_error" class="usa-radio__input" id="Transactions_0__WasSent_no" required="" type="radio" value="false" name="Transactions[0].WasSent">
<label class="usa-radio__label" for="Transactions_0__WasSent_no">No</label>
</div>
<div class="val-error" id="Transactions_0__WasSent_error"></div>
</fieldset>
<fieldset class="noborder tall fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__Amount"><abbr class="usa-hint--required" title="Required">*</abbr>Transaction Amount: </label><input type="number"
min="0" max="999999999.99" step="0.01" class="amount usa-input inline" required="" data-ordinal="0.04" aria-errormessage="Transactions_0__Amount_error" data-val="true"
data-val-range="The Amount for transaction #1 must be a positive value less than $999,999,999.99." data-val-range-max="999999999.99" data-val-range-min="0"
data-val-required-when="The Amount for transaction #1 must have a value when there is a transaction." data-val-required-when-allowempty="false" data-val-required-when-input="Transactions[0].TransactionType"
data-val-required-when-op="ne" data-val-required-when-target="" id="Transactions_0__Amount" name="Transactions[0].Amount" value="">
<div class="val-error" id="Transactions_0__Amount_error"></div>
</fieldset>
<fieldset class="noborder tall fieldset-contingent date" disabled=""><label class="usa-label inline" for="Transactions_0__Date"><abbr class="usa-hint--required" title="Required">*</abbr>Transaction Date:</label><input
class="transaction-date usa-input inline" required="" data-ordinal="0.05" type="date" data-val="true" data-val-range="The Transaction Date for transaction #1 must not be in the future."
data-val-required-when="The Transaction Date for transaction #1 must have a value when there is a transaction." data-val-required-when-allowempty="false" data-val-required-when-input="Transactions[0].TransactionType"
data-val-required-when-op="ne" data-val-required-when-target="" id="Transactions_0__Date" max="2024-11-10" name="Transactions[0].Date" value="" aria-errormessage="Transactions_0__Date_error">
<div class="val-error" id="Transactions_0__Date_error"></div>
</fieldset>
<fieldset class="usa-fieldset tall fieldset-contingent" data-ordinal="0.06" disabled="">
<legend class="usa-legend usa-label">Did you contact your bank, financial institution, or cryptocurrency exchange?</legend>
<div class="usa-radio">
<input aria-errormessage="Transactions_0__InstitutionNotified_error" class="usa-radio__input" id="Transactions_0__InstitutionNotified_yes" type="radio" value="true" name="Transactions[0].InstitutionNotified">
<label class="usa-radio__label" for="Transactions_0__InstitutionNotified_yes">Yes</label>
<input aria-errormessage="Transactions_0__InstitutionNotified_error" class="usa-radio__input" id="Transactions_0__InstitutionNotified_no" type="radio" value="false" name="Transactions[0].InstitutionNotified">
<label class="usa-radio__label" for="Transactions_0__InstitutionNotified_no">No</label>
</div>
<div class="val-error" id="Transactions_0__InstitutionNotified_error"></div>
</fieldset>
<hr class="opacity-0 transaction--disabled-fields__separator" data-ordinal="1">
<fieldset class="noborder t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__VictimBankName">Originating Bank Name: </label><input data-ordinal="110"
aria-errormessage="Transactions_0__VictimBankName_error" class="usa-input inline" data-val="true" data-val-length="The Originating Bank Name for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__VictimBankName" maxlength="50" name="Transactions[0].VictimBankName" type="text" value="">
<div class="val-error" id="Transactions_0__VictimBankName_error"></div>
</fieldset>
<fieldset class="noborder t6 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__CryptocurrencyType">Type of Cryptocurrency: </label><input data-ordinal="110"
class="cc-type usa-input inline margin-right-05" aria-errormessage="Transactions_0__CryptocurrencyType_error" data-val="true" data-val-length="The Type of Cryptocurrency for transaction #1 must be no longer than 50 characters."
data-val-length-max="50" id="Transactions_0__CryptocurrencyType" maxlength="50" name="Transactions[0].CryptocurrencyType" type="text"
value=""><a class="ic3-open-modal" href="#" aria-controls="cryptoCurrencyTypeDef" aria-label="Get help with the definition of type of cryptocurrency" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a>
<div class="val-error" id="Transactions_0__CryptocurrencyType_error"></div>
</fieldset>
<fieldset class="noborder t7 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__P2PApplication">P2P Application Used: </label><input data-ordinal="110"
aria-errormessage="Transactions_0__P2PApplication_error" class="usa-input inline" data-val="true" data-val-length="The P2P Application Used field for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__P2PApplication" maxlength="50" name="Transactions[0].P2PApplication" type="text" value="">
<div class="val-error" id="Transactions_0__P2PApplication_error"></div>
</fieldset>
<fieldset class="noborder t5 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__GiftCardType">Type of Prepaid/Gift Card: </label><input class="gift-card-type usa-input inline margin-right-05"
data-ordinal="110" aria-errormessage="Transactions_0__GiftCardType_error" data-val="true" data-val-length="The Type of Prepaid/Gift Card field for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__GiftCardType" maxlength="50" name="Transactions[0].GiftCardType" type="text"
value=""><a class="ic3-open-modal" href="#" aria-controls="giftCardTypeDef" aria-label="Get help with the definition of Prepaid/Gift Card Type" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a>
<div class="val-error" id="Transactions_0__GiftCardType_error"></div>
</fieldset>
<fieldset class="noborder t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__VictimBankAddress1">Originating Bank Address: </label><input data-ordinal="120"
aria-errormessage="Transactions_0__VictimBankAddress1_error" class="usa-input inline" data-val="true" data-val-length="The Originating Bank Address for transaction #1 must be no longer than 75 characters." data-val-length-max="75"
id="Transactions_0__VictimBankAddress1" maxlength="75" name="Transactions[0].VictimBankAddress1" type="text" value="">
<div class="val-error" id="Transactions_0__VictimBankAddress1_error"></div>
</fieldset>
<fieldset class="noborder t6 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__TransactionID">Transaction ID/Hash: </label><input data-ordinal="120" class="txn-hash usa-input inline margin-right-05"
aria-errormessage="Transactions_0__TransactionID_error" data-val="true" data-val-length="The Transaction ID for transaction #1 must be no longer than 75 characters." data-val-length-max="75" id="Transactions_0__TransactionID"
maxlength="75" name="Transactions[0].TransactionID" type="text"
value=""><a class="ic3-open-modal" href="#" aria-controls="txnHashDef" aria-label="Get help with the definition of type of transaction ID or hash" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a>
<div class="val-error" id="Transactions_0__TransactionID_error"></div>
</fieldset>
<fieldset class="noborder label-sm t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__VictimBankAddress2">Originating Bank Address (cont.): </label><input data-ordinal="130"
aria-errormessage="Transactions_0__VictimBankAddress2_error" class="usa-input inline" data-val="true" data-val-length="The Originating Bank Address (cont.) for transaction #1 must be no longer than 75 characters."
data-val-length-max="75" id="Transactions_0__VictimBankAddress2" maxlength="75" name="Transactions[0].VictimBankAddress2" type="text" value="">
<div class="val-error" id="Transactions_0__VictimBankAddress2_error"></div>
</fieldset>
<fieldset class="noborder t6 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__CryptoATM">Cryptocurrency ATM/Kiosk: </label><input data-ordinal="130" class="cc-atm usa-input inline margin-right-05"
aria-errormessage="Transactions_0__CryptoATM_error" data-val="true" data-val-length="The Cryptocurrency ATM/Kiosk for transaction #1 must be no longer than 50 characters." data-val-length-max="50" id="Transactions_0__CryptoATM"
maxlength="50" name="Transactions[0].CryptoATM" type="text"
value=""><a class="ic3-open-modal" href="#" aria-controls="cryptoCurrencyAtmDef" aria-label="Get help with the definition of cryptocurrency ATM/kiosk name" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a>
<div class="val-error" id="Transactions_0__CryptoATM_error"></div>
</fieldset>
<fieldset class="noborder label-sm t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__VictimBankMailStop">Originating Bank Suite/Mail Stop: </label><input data-ordinal="140"
aria-errormessage="Transactions_0__VictimBankMailStop_error" class="usa-input inline" data-val="true" data-val-length="The Originating Bank Suite/Mail Stop for transaction #1 must be no longer than 75 characters."
data-val-length-max="75" id="Transactions_0__VictimBankMailStop" maxlength="75" name="Transactions[0].VictimBankMailStop" type="text" value="">
<div class="val-error" id="Transactions_0__VictimBankMailStop_error"></div>
</fieldset>
<fieldset class="noborder t6 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__ATMAddress">ATM/Kiosk Address: </label><input data-ordinal="140" class="cc-atm-add usa-input inline margin-right-05"
aria-errormessage="Transactions_0__ATMAddress_error" data-val="true" data-val-length="The ATM/Kiosk Address for transaction #1 must be no longer than 75 characters." data-val-length-max="75" id="Transactions_0__ATMAddress"
maxlength="75" name="Transactions[0].ATMAddress" type="text"
value=""><a class="ic3-open-modal" href="#" aria-controls="cryptoCurrencyAtmAddressDef" aria-label="Get help with the definition of cryptocurrency ATM/kiosk address" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a>
<div class="val-error" id="Transactions_0__ATMAddress_error"></div>
</fieldset>
<fieldset class="noborder t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__VictimBankCity">Originating Bank City: </label><input data-ordinal="150"
aria-errormessage="Transactions_0__VictimBankCity_error" class="usa-input inline" data-val="true" data-val-length="The Originating Bank City for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__VictimBankCity" maxlength="50" name="Transactions[0].VictimBankCity" type="text" value="">
<div class="val-error" id="Transactions_0__VictimBankCity_error"></div>
</fieldset>
<fieldset class="noborder t6 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__ATMCity">ATM/Kiosk City: </label><input data-ordinal="150" aria-errormessage="Transactions_0__ATMCity_error"
class="usa-input inline" data-val="true" data-val-length="The ATM/Kiosk City for transaction #1 must be no longer than 50 characters." data-val-length-max="50" id="Transactions_0__ATMCity" maxlength="50" name="Transactions[0].ATMCity"
type="text" value="">
<div class="val-error" id="Transactions_0__ATMCity_error"></div>
</fieldset>
<fieldset class="noborder t6 fieldset-contingent" data-ordinal="160" data-target="Transactions_0__ATMStateFields" data-target-value="USA" disabled="">
<label class="usa-label inline" for="Transactions_0__ATMCountry">ATM/Kiosk Country: </label>
<select class="usa-select inline" aria-errormessage="Transactions_0__ATMCountryError" id="Transactions_0__ATMCountry" name="Transactions[0].ATMCountry">
<option value="">[None]</option>
<optgroup label="">
<option value="USA">United States of America</option>
<option value="AFG">Afghanistan</option>
<option value="ALA">Åland Islands</option>
<option value="ALB">Albania</option>
<option value="DZA">Algeria</option>
<option value="AND">Andorra</option>
<option value="AGO">Angola</option>
<option value="AIA">Anguilla</option>
<option value="ATA">Antarctica</option>
<option value="ATG">Antigua and Barbuda</option>
<option value="ARG">Argentina</option>
<option value="ARM">Armenia</option>
<option value="ABW">Aruba</option>
<option value="AUS">Australia</option>
<option value="AUT">Austria</option>
<option value="AZE">Azerbaijan</option>
<option value="BHS">Bahamas</option>
<option value="BHR">Bahrain</option>
<option value="BGD">Bangladesh</option>
<option value="BRB">Barbados</option>
<option value="BLR">Belarus</option>
<option value="BEL">Belgium</option>
<option value="BLZ">Belize</option>
<option value="BEN">Benin</option>
<option value="BMU">Bermuda</option>
<option value="BTN">Bhutan</option>
<option value="BOL">Bolivia (Plurinational State of)</option>
<option value="BES">Bonaire, Sint Eustatius and Saba</option>
<option value="BIH">Bosnia and Herzegovina</option>
<option value="BWA">Botswana</option>
<option value="BVT">Bouvet Island</option>
<option value="BRA">Brazil</option>
<option value="IOT">British Indian Ocean Territory</option>
<option value="BRN">Brunei Darussalam</option>
<option value="BGR">Bulgaria</option>
<option value="BFA">Burkina Faso</option>
<option value="BDI">Burundi</option>
<option value="CPV">Cabo Verde</option>
<option value="KHM">Cambodia</option>
<option value="CMR">Cameroon</option>
<option value="CAN">Canada</option>
<option value="CYM">Cayman Islands</option>
<option value="CAF">Central African Republic</option>
<option value="TCD">Chad</option>
<option value="CHL">Chile</option>
<option value="CHN">China</option>
<option value="CXR">Christmas Island</option>
<option value="CCK">Cocos (Keeling) Islands</option>
<option value="COL">Colombia</option>
<option value="COM">Comoros</option>
<option value="COG">Congo</option>
<option value="COD">Congo (Democratic Republic of the)</option>
<option value="COK">Cook Islands</option>
<option value="CRI">Costa Rica</option>
<option value="CIV">Côte d'Ivoire</option>
<option value="HRV">Croatia</option>
<option value="CUB">Cuba</option>
<option value="CUW">Curaçao</option>
<option value="CYP">Cyprus</option>
<option value="CZE">Czech Republic</option>
<option value="DNK">Denmark</option>
<option value="DJI">Djibouti</option>
<option value="DMA">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="ECU">Ecuador</option>
<option value="EGY">Egypt</option>
<option value="SLV">El Salvador</option>
<option value="GNQ">Equatorial Guinea</option>
<option value="ERI">Eritrea</option>
<option value="EST">Estonia</option>
<option value="ETH">Ethiopia</option>
<option value="FLK">Falkland Islands (Malvinas)</option>
<option value="FRO">Faroe Islands</option>
<option value="FJI">Fiji</option>
<option value="FIN">Finland</option>
<option value="FRA">France</option>
<option value="GUF">French Guiana</option>
<option value="PYF">French Polynesia</option>
<option value="ATF">French Southern Territories</option>
<option value="GAB">Gabon</option>
<option value="GMB">Gambia</option>
<option value="GEO">Georgia</option>
<option value="DEU">Germany</option>
<option value="GHA">Ghana</option>
<option value="GIB">Gibraltar</option>
<option value="GRC">Greece</option>
<option value="GRL">Greenland</option>
<option value="GRD">Grenada</option>
<option value="GLP">Guadeloupe</option>
<option value="GTM">Guatemala</option>
<option value="GGY">Guernsey</option>
<option value="GIN">Guinea</option>
<option value="GNB">Guinea-Bissau</option>
<option value="GUY">Guyana</option>
<option value="HTI">Haiti</option>
<option value="HMD">Heard Island and McDonald Islands</option>
<option value="VAT">Holy See</option>
<option value="HND">Honduras</option>
<option value="HKG">Hong Kong</option>
<option value="HUN">Hungary</option>
<option value="ISL">Iceland</option>
<option value="IND">India</option>
<option value="IDN">Indonesia</option>
<option value="IRN">Iran (Islamic Republic of)</option>
<option value="IRQ">Iraq</option>
<option value="IRL">Ireland</option>
<option value="IMN">Isle of Man</option>
<option value="ISR">Israel</option>
<option value="ITA">Italy</option>
<option value="JAM">Jamaica</option>
<option value="JPN">Japan</option>
<option value="JEY">Jersey</option>
<option value="JOR">Jordan</option>
<option value="KAZ">Kazakhstan</option>
<option value="KEN">Kenya</option>
<option value="KIR">Kiribati</option>
<option value="PRK">Korea (Democratic People's Republic of)</option>
<option value="KOR">Korea (Republic of)</option>
<option value="KWT">Kuwait</option>
<option value="KGZ">Kyrgyzstan</option>
<option value="LAO">Lao People's Democratic Republic</option>
<option value="LVA">Latvia</option>
<option value="LBN">Lebanon</option>
<option value="LSO">Lesotho</option>
<option value="LBR">Liberia</option>
<option value="LBY">Libya</option>
<option value="LIE">Liechtenstein</option>
<option value="LTU">Lithuania</option>
<option value="LUX">Luxembourg</option>
<option value="MAC">Macao</option>
<option value="MDG">Madagascar</option>
<option value="MWI">Malawi</option>
<option value="MYS">Malaysia</option>
<option value="MDV">Maldives</option>
<option value="MLI">Mali</option>
<option value="MLT">Malta</option>
<option value="MHL">Marshall Islands</option>
<option value="MTQ">Martinique</option>
<option value="MRT">Mauritania</option>
<option value="MUS">Mauritius</option>
<option value="MYT">Mayotte</option>
<option value="MEX">Mexico</option>
<option value="FSM">Micronesia (Federated States of)</option>
<option value="MDA">Moldova (Republic of)</option>
<option value="MCO">Monaco</option>
<option value="MNG">Mongolia</option>
<option value="MNE">Montenegro</option>
<option value="MSR">Montserrat</option>
<option value="MAR">Morocco</option>
<option value="MOZ">Mozambique</option>
<option value="MMR">Myanmar</option>
<option value="NAM">Namibia</option>
<option value="NRU">Nauru</option>
<option value="NPL">Nepal</option>
<option value="NLD">Netherlands</option>
<option value="NCL">New Caledonia</option>
<option value="NZL">New Zealand</option>
<option value="NIC">Nicaragua</option>
<option value="NER">Niger</option>
<option value="NGA">Nigeria</option>
<option value="NIU">Niue</option>
<option value="NFK">Norfolk Island</option>
<option value="MKD">North Macedonia</option>
<option value="NOR">Norway</option>
<option value="OMN">Oman</option>
<option value="PAK">Pakistan</option>
<option value="PLW">Palau</option>
<option value="PSE">Palestinian Territory, Occupied</option>
<option value="PAN">Panama</option>
<option value="PNG">Papua New Guinea</option>
<option value="PRY">Paraguay</option>
<option value="PER">Peru</option>
<option value="PHL">Philippines</option>
<option value="PCN">Pitcairn</option>
<option value="POL">Poland</option>
<option value="PRT">Portugal</option>
<option value="QAT">Qatar</option>
<option value="REU">Réunion</option>
<option value="ROU">Romania</option>
<option value="RUS">Russian Federation</option>
<option value="RWA">Rwanda</option>
<option value="BLM">Saint Barthélemy</option>
<option value="SHN">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KNA">Saint Kitts and Nevis</option>
<option value="LCA">Saint Lucia</option>
<option value="MAF">Saint Martin (French part)</option>
<option value="SPM">Saint Pierre and Miquelon</option>
<option value="VCT">Saint Vincent and the Grenadines</option>
<option value="WSM">Samoa</option>
<option value="SMR">San Marino</option>
<option value="STP">Sao Tome and Principe</option>
<option value="SAU">Saudi Arabia</option>
<option value="SEN">Senegal</option>
<option value="SRB">Serbia</option>
<option value="SYC">Seychelles</option>
<option value="SLE">Sierra Leone</option>
<option value="SGP">Singapore</option>
<option value="SXM">Sint Maarten (Dutch part)</option>
<option value="SVK">Slovakia</option>
<option value="SVN">Slovenia</option>
<option value="SLB">Solomon Islands</option>
<option value="SOM">Somalia</option>
<option value="ZAF">South Africa</option>
<option value="SGS">South Georgia and the South Sandwich Islands</option>
<option value="SSD">South Sudan</option>
<option value="ESP">Spain</option>
<option value="LKA">Sri Lanka</option>
<option value="SDN">Sudan</option>
<option value="SUR">Suriname</option>
<option value="SJM">Svalbard and Jan Mayen</option>
<option value="SWZ">Swaziland</option>
<option value="SWE">Sweden</option>
<option value="CHE">Switzerland</option>
<option value="SYR">Syrian Arab Republic</option>
<option value="TWN">Taiwan</option>
<option value="TJK">Tajikistan</option>
<option value="TZA">Tanzania, United Republic of</option>
<option value="THA">Thailand</option>
<option value="TLS">Timor-Leste</option>
<option value="TGO">Togo</option>
<option value="TKL">Tokelau</option>
<option value="TON">Tonga</option>
<option value="TTO">Trinidad and Tobago</option>
<option value="TUN">Tunisia</option>
<option value="TUR">Turkey</option>
<option value="TKM">Turkmenistan</option>
<option value="TCA">Turks and Caicos Islands</option>
<option value="TUV">Tuvalu</option>
<option value="UGA">Uganda</option>
<option value="UKR">Ukraine</option>
<option value="ARE">United Arab Emirates</option>
<option value="GBR">United Kingdom</option>
<option value="USA">United States of America</option>
<option value="URY">Uruguay</option>
<option value="UZB">Uzbekistan</option>
<option value="VUT">Vanuatu</option>
<option value="VEN">Venezuela (Bolivarian Republic of)</option>
<option value="VNM">Viet Nam</option>
<option value="VGB">Virgin Islands (British)</option>
<option value="WLF">Wallis and Futuna</option>
<option value="ESH">Western Sahara</option>
<option value="YEM">Yemen</option>
<option value="ZMB">Zambia</option>
<option value="ZWE">Zimbabwe</option>
</optgroup>
</select>
<div class="val-error" id="Transactions_0__ATMCountryError"></div>
</fieldset>
<fieldset class="noborder t1 t2 t3 t4 t8 fieldset-contingent" data-ordinal="160" data-target="Transactions_0__VictimBankStateFields" data-target-value="USA" disabled="">
<label class="usa-label inline" for="Transactions_0__VictimBankCountry">Originating Bank Country: </label>
<select class="usa-select inline" aria-errormessage="Transactions_0__VictimBankCountryError" id="Transactions_0__VictimBankCountry" name="Transactions[0].VictimBankCountry">
<option value="">[None]</option>
<optgroup label="">
<option value="USA">United States of America</option>
<option value="AFG">Afghanistan</option>
<option value="ALA">Åland Islands</option>
<option value="ALB">Albania</option>
<option value="DZA">Algeria</option>
<option value="AND">Andorra</option>
<option value="AGO">Angola</option>
<option value="AIA">Anguilla</option>
<option value="ATA">Antarctica</option>
<option value="ATG">Antigua and Barbuda</option>
<option value="ARG">Argentina</option>
<option value="ARM">Armenia</option>
<option value="ABW">Aruba</option>
<option value="AUS">Australia</option>
<option value="AUT">Austria</option>
<option value="AZE">Azerbaijan</option>
<option value="BHS">Bahamas</option>
<option value="BHR">Bahrain</option>
<option value="BGD">Bangladesh</option>
<option value="BRB">Barbados</option>
<option value="BLR">Belarus</option>
<option value="BEL">Belgium</option>
<option value="BLZ">Belize</option>
<option value="BEN">Benin</option>
<option value="BMU">Bermuda</option>
<option value="BTN">Bhutan</option>
<option value="BOL">Bolivia (Plurinational State of)</option>
<option value="BES">Bonaire, Sint Eustatius and Saba</option>
<option value="BIH">Bosnia and Herzegovina</option>
<option value="BWA">Botswana</option>
<option value="BVT">Bouvet Island</option>
<option value="BRA">Brazil</option>
<option value="IOT">British Indian Ocean Territory</option>
<option value="BRN">Brunei Darussalam</option>
<option value="BGR">Bulgaria</option>
<option value="BFA">Burkina Faso</option>
<option value="BDI">Burundi</option>
<option value="CPV">Cabo Verde</option>
<option value="KHM">Cambodia</option>
<option value="CMR">Cameroon</option>
<option value="CAN">Canada</option>
<option value="CYM">Cayman Islands</option>
<option value="CAF">Central African Republic</option>
<option value="TCD">Chad</option>
<option value="CHL">Chile</option>
<option value="CHN">China</option>
<option value="CXR">Christmas Island</option>
<option value="CCK">Cocos (Keeling) Islands</option>
<option value="COL">Colombia</option>
<option value="COM">Comoros</option>
<option value="COG">Congo</option>
<option value="COD">Congo (Democratic Republic of the)</option>
<option value="COK">Cook Islands</option>
<option value="CRI">Costa Rica</option>
<option value="CIV">Côte d'Ivoire</option>
<option value="HRV">Croatia</option>
<option value="CUB">Cuba</option>
<option value="CUW">Curaçao</option>
<option value="CYP">Cyprus</option>
<option value="CZE">Czech Republic</option>
<option value="DNK">Denmark</option>
<option value="DJI">Djibouti</option>
<option value="DMA">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="ECU">Ecuador</option>
<option value="EGY">Egypt</option>
<option value="SLV">El Salvador</option>
<option value="GNQ">Equatorial Guinea</option>
<option value="ERI">Eritrea</option>
<option value="EST">Estonia</option>
<option value="ETH">Ethiopia</option>
<option value="FLK">Falkland Islands (Malvinas)</option>
<option value="FRO">Faroe Islands</option>
<option value="FJI">Fiji</option>
<option value="FIN">Finland</option>
<option value="FRA">France</option>
<option value="GUF">French Guiana</option>
<option value="PYF">French Polynesia</option>
<option value="ATF">French Southern Territories</option>
<option value="GAB">Gabon</option>
<option value="GMB">Gambia</option>
<option value="GEO">Georgia</option>
<option value="DEU">Germany</option>
<option value="GHA">Ghana</option>
<option value="GIB">Gibraltar</option>
<option value="GRC">Greece</option>
<option value="GRL">Greenland</option>
<option value="GRD">Grenada</option>
<option value="GLP">Guadeloupe</option>
<option value="GTM">Guatemala</option>
<option value="GGY">Guernsey</option>
<option value="GIN">Guinea</option>
<option value="GNB">Guinea-Bissau</option>
<option value="GUY">Guyana</option>
<option value="HTI">Haiti</option>
<option value="HMD">Heard Island and McDonald Islands</option>
<option value="VAT">Holy See</option>
<option value="HND">Honduras</option>
<option value="HKG">Hong Kong</option>
<option value="HUN">Hungary</option>
<option value="ISL">Iceland</option>
<option value="IND">India</option>
<option value="IDN">Indonesia</option>
<option value="IRN">Iran (Islamic Republic of)</option>
<option value="IRQ">Iraq</option>
<option value="IRL">Ireland</option>
<option value="IMN">Isle of Man</option>
<option value="ISR">Israel</option>
<option value="ITA">Italy</option>
<option value="JAM">Jamaica</option>
<option value="JPN">Japan</option>
<option value="JEY">Jersey</option>
<option value="JOR">Jordan</option>
<option value="KAZ">Kazakhstan</option>
<option value="KEN">Kenya</option>
<option value="KIR">Kiribati</option>
<option value="PRK">Korea (Democratic People's Republic of)</option>
<option value="KOR">Korea (Republic of)</option>
<option value="KWT">Kuwait</option>
<option value="KGZ">Kyrgyzstan</option>
<option value="LAO">Lao People's Democratic Republic</option>
<option value="LVA">Latvia</option>
<option value="LBN">Lebanon</option>
<option value="LSO">Lesotho</option>
<option value="LBR">Liberia</option>
<option value="LBY">Libya</option>
<option value="LIE">Liechtenstein</option>
<option value="LTU">Lithuania</option>
<option value="LUX">Luxembourg</option>
<option value="MAC">Macao</option>
<option value="MDG">Madagascar</option>
<option value="MWI">Malawi</option>
<option value="MYS">Malaysia</option>
<option value="MDV">Maldives</option>
<option value="MLI">Mali</option>
<option value="MLT">Malta</option>
<option value="MHL">Marshall Islands</option>
<option value="MTQ">Martinique</option>
<option value="MRT">Mauritania</option>
<option value="MUS">Mauritius</option>
<option value="MYT">Mayotte</option>
<option value="MEX">Mexico</option>
<option value="FSM">Micronesia (Federated States of)</option>
<option value="MDA">Moldova (Republic of)</option>
<option value="MCO">Monaco</option>
<option value="MNG">Mongolia</option>
<option value="MNE">Montenegro</option>
<option value="MSR">Montserrat</option>
<option value="MAR">Morocco</option>
<option value="MOZ">Mozambique</option>
<option value="MMR">Myanmar</option>
<option value="NAM">Namibia</option>
<option value="NRU">Nauru</option>
<option value="NPL">Nepal</option>
<option value="NLD">Netherlands</option>
<option value="NCL">New Caledonia</option>
<option value="NZL">New Zealand</option>
<option value="NIC">Nicaragua</option>
<option value="NER">Niger</option>
<option value="NGA">Nigeria</option>
<option value="NIU">Niue</option>
<option value="NFK">Norfolk Island</option>
<option value="MKD">North Macedonia</option>
<option value="NOR">Norway</option>
<option value="OMN">Oman</option>
<option value="PAK">Pakistan</option>
<option value="PLW">Palau</option>
<option value="PSE">Palestinian Territory, Occupied</option>
<option value="PAN">Panama</option>
<option value="PNG">Papua New Guinea</option>
<option value="PRY">Paraguay</option>
<option value="PER">Peru</option>
<option value="PHL">Philippines</option>
<option value="PCN">Pitcairn</option>
<option value="POL">Poland</option>
<option value="PRT">Portugal</option>
<option value="QAT">Qatar</option>
<option value="REU">Réunion</option>
<option value="ROU">Romania</option>
<option value="RUS">Russian Federation</option>
<option value="RWA">Rwanda</option>
<option value="BLM">Saint Barthélemy</option>
<option value="SHN">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KNA">Saint Kitts and Nevis</option>
<option value="LCA">Saint Lucia</option>
<option value="MAF">Saint Martin (French part)</option>
<option value="SPM">Saint Pierre and Miquelon</option>
<option value="VCT">Saint Vincent and the Grenadines</option>
<option value="WSM">Samoa</option>
<option value="SMR">San Marino</option>
<option value="STP">Sao Tome and Principe</option>
<option value="SAU">Saudi Arabia</option>
<option value="SEN">Senegal</option>
<option value="SRB">Serbia</option>
<option value="SYC">Seychelles</option>
<option value="SLE">Sierra Leone</option>
<option value="SGP">Singapore</option>
<option value="SXM">Sint Maarten (Dutch part)</option>
<option value="SVK">Slovakia</option>
<option value="SVN">Slovenia</option>
<option value="SLB">Solomon Islands</option>
<option value="SOM">Somalia</option>
<option value="ZAF">South Africa</option>
<option value="SGS">South Georgia and the South Sandwich Islands</option>
<option value="SSD">South Sudan</option>
<option value="ESP">Spain</option>
<option value="LKA">Sri Lanka</option>
<option value="SDN">Sudan</option>
<option value="SUR">Suriname</option>
<option value="SJM">Svalbard and Jan Mayen</option>
<option value="SWZ">Swaziland</option>
<option value="SWE">Sweden</option>
<option value="CHE">Switzerland</option>
<option value="SYR">Syrian Arab Republic</option>
<option value="TWN">Taiwan</option>
<option value="TJK">Tajikistan</option>
<option value="TZA">Tanzania, United Republic of</option>
<option value="THA">Thailand</option>
<option value="TLS">Timor-Leste</option>
<option value="TGO">Togo</option>
<option value="TKL">Tokelau</option>
<option value="TON">Tonga</option>
<option value="TTO">Trinidad and Tobago</option>
<option value="TUN">Tunisia</option>
<option value="TUR">Turkey</option>
<option value="TKM">Turkmenistan</option>
<option value="TCA">Turks and Caicos Islands</option>
<option value="TUV">Tuvalu</option>
<option value="UGA">Uganda</option>
<option value="UKR">Ukraine</option>
<option value="ARE">United Arab Emirates</option>
<option value="GBR">United Kingdom</option>
<option value="USA">United States of America</option>
<option value="URY">Uruguay</option>
<option value="UZB">Uzbekistan</option>
<option value="VUT">Vanuatu</option>
<option value="VEN">Venezuela (Bolivarian Republic of)</option>
<option value="VNM">Viet Nam</option>
<option value="VGB">Virgin Islands (British)</option>
<option value="WLF">Wallis and Futuna</option>
<option value="ESH">Western Sahara</option>
<option value="YEM">Yemen</option>
<option value="ZMB">Zambia</option>
<option value="ZWE">Zimbabwe</option>
</optgroup>
</select>
<div class="val-error" id="Transactions_0__VictimBankCountryError"></div>
</fieldset>
<fieldset id="Transactions_0__ATMStateFields" class="state noborder t6 fieldset-contingent" data-ordinal="165" disabled="">
<label class="usa-label inline" for="Transactions_0__ATMState">ATM/Kiosk State: </label>
<select class="usa-select inline" aria-errormessage="Transactions_0__ATMStateError" data-val="true"
data-val-required-when="The ATM/Kiosk State field for transaction #1 is required if the ATM/Kiosk Country is the United States of America." data-val-required-when-allowempty="false"
data-val-required-when-input="Transactions[0].ATMCountry" data-val-required-when-op="eq" data-val-required-when-target="USA" id="Transactions_0__ATMState" name="Transactions[0].ATMState">
<option value="">[None]</option>
<optgroup label="">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</optgroup>
</select>
<div class="val-error" id="Transactions_0__ATMStateError"></div>
</fieldset>
<fieldset id="Transactions_0__VictimBankStateFields" class="state noborder t1 t2 t3 t4 t8 fieldset-contingent" data-ordinal="165" disabled="">
<label class="usa-label inline" for="Transactions_0__VictimBankState">Originating Bank State: </label>
<select class="usa-select inline" aria-errormessage="Transactions_0__VictimBankStateError" data-val="true"
data-val-required-when="The Victim Bank State field for transaction #1 is required if the Victim Bank Country is the United States of America." data-val-required-when-allowempty="false"
data-val-required-when-input="Transactions[0].VictimBankCountry" data-val-required-when-op="eq" data-val-required-when-target="USA" id="Transactions_0__VictimBankState" name="Transactions[0].VictimBankState">
<option value="">[None]</option>
<optgroup label="">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</optgroup>
</select>
<div class="val-error" id="Transactions_0__VictimBankStateError"></div>
</fieldset>
<fieldset class="noborder label-sm t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__VictimBankZipCode">Originating Bank Zip Code/Route: </label><input data-ordinal="170"
aria-errormessage="Transactions_0__VictimBankZipCode_error" class="usa-input inline" data-val="true" data-val-length="The Originating Bank Zip Code for transaction #1 must be no longer than 20 characters." data-val-length-max="20"
id="Transactions_0__VictimBankZipCode" maxlength="20" name="Transactions[0].VictimBankZipCode" type="text" value="">
<div class="val-error" id="Transactions_0__VictimBankZipCode_error"></div>
</fieldset>
<fieldset class="noborder t6 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__ATMZipCode">ATM/Kiosk Zip Code/Route: </label><input data-ordinal="170"
aria-errormessage="Transactions_0__ATMZipCode_error" class="usa-input inline" data-val="true" data-val-length="The ATM/Kiosk Zip Code for transaction #1 must be no longer than 20 characters." data-val-length-max="20"
id="Transactions_0__ATMZipCode" maxlength="20" name="Transactions[0].ATMZipCode" type="text" value="">
<div class="val-error" id="Transactions_0__ATMZipCode_error"></div>
</fieldset>
<fieldset class="noborder t1 t2 t3 t4 t7 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__VictimAccountName">Originating Name on Account: </label><input data-ordinal="180"
aria-errormessage="Transactions_0__VictimAccountName_error" class="usa-input inline" data-val="true" data-val-length="The Originating Account Name for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__VictimAccountName" maxlength="50" name="Transactions[0].VictimAccountName" type="text" value="">
<div class="val-error" id="Transactions_0__VictimAccountName_error"></div>
</fieldset>
<fieldset class="noborder t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__VictimAccountNumber">Originating Account Number: </label><input data-ordinal="190"
aria-errormessage="Transactions_0__VictimAccountNumber_error" class="usa-input inline" data-val="true" data-val-length="The Originating Account Number for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__VictimAccountNumber" maxlength="50" name="Transactions[0].VictimAccountNumber" type="text" value="">
<div class="val-error" id="Transactions_0__VictimAccountNumber_error"></div>
</fieldset>
<fieldset class="noborder t6 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__VictimAccountWallet">Originating Wallet Address: </label><input class="cc-orig-wallet usa-input inline margin-right-05"
data-ordinal="190" aria-errormessage="Transactions_0__VictimAccountWallet_error" data-val="true" data-val-length="The Originating Account/Wallet for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__VictimAccountWallet" maxlength="50" name="Transactions[0].VictimAccountWallet" type="text"
value=""><a class="ic3-open-modal" href="#" aria-controls="cryptoCurrencyOrigAddressDef" aria-label="Get help with the definition of cryptocurrency originating wallet address" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a>
<div class="val-error" id="Transactions_0__VictimAccountWallet_error"></div>
</fieldset>
<fieldset class="noborder t7 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__VictimAccountIdentifier">Originating Account Identifier: </label><input
class="transaction-account-num usa-input inline margin-right-05" data-ordinal="190" aria-errormessage="Transactions_0__VictimAccountIdentifier_error" data-val="true"
data-val-length="The Originating Account Identifier for transaction #1 must be no longer than 50 characters." data-val-length-max="50" id="Transactions_0__VictimAccountIdentifier" maxlength="50"
name="Transactions[0].VictimAccountIdentifier" type="text"
value=""><a class="ic3-open-modal" href="#" aria-controls="p2pAccountIdDef" aria-label="Get help with the definition of P2P account identifier" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a>
<div class="val-error" id="Transactions_0__VictimAccountIdentifier_error"></div>
</fieldset>
<fieldset class="noborder t5 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__GiftCardNumber">Prepaid/Gift Card Number: </label><input data-ordinal="190"
aria-errormessage="Transactions_0__GiftCardNumber_error" class="usa-input inline" data-val="true" data-val-length="The Prepaid/Gift Card Number for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__GiftCardNumber" maxlength="50" name="Transactions[0].GiftCardNumber" type="text" value="">
<div class="val-error" id="Transactions_0__GiftCardNumber_error"></div>
</fieldset>
<hr class="opacity-0 transaction--disabled-fields__separator" data-ordinal="1000">
<fieldset class="noborder t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientBankName">Recipient Bank Name: </label><input data-ordinal="1100"
aria-errormessage="Transactions_0__RecipientBankName_error" class="usa-input inline" data-val="true" data-val-length="The Recipient Bank Name for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__RecipientBankName" maxlength="50" name="Transactions[0].RecipientBankName" type="text" value="">
<div class="val-error" id="Transactions_0__RecipientBankName_error"></div>
</fieldset>
<fieldset class="noborder t0 t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientBankAddress1">Recipient Bank Address: </label><input data-ordinal="1110"
aria-errormessage="Transactions_0__RecipientBankAddress1_error" class="usa-input inline" data-val="true" data-val-length="The Recipient Bank Address for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__RecipientBankAddress1" maxlength="50" name="Transactions[0].RecipientBankAddress1" type="text" value="">
<div class="val-error" id="Transactions_0__RecipientBankAddress1_error"></div>
</fieldset>
<fieldset class="noborder label-sm t0 t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientBankAddress2">Recipient Bank Address (cont.): </label><input data-ordinal="1120"
aria-errormessage="Transactions_0__RecipientBankAddress2_error" class="usa-input inline" data-val="true" data-val-length="The Recipient Bank Address (cont.) for transaction #1 must be no longer than 50 characters."
data-val-length-max="50" id="Transactions_0__RecipientBankAddress2" maxlength="50" name="Transactions[0].RecipientBankAddress2" type="text" value="">
<div class="val-error" id="Transactions_0__RecipientBankAddress2_error"></div>
</fieldset>
<fieldset class="noborder label-sm t0 t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientBankMailStop">Recipient Bank Suite/Mail Stop: </label><input data-ordinal="1130"
aria-errormessage="Transactions_0__RecipientBankMailStop_error" class="usa-input inline" data-val="true" data-val-length="The Recipient Bank Suite/Mail Stop for transaction #1 must be no longer than 50 characters."
data-val-length-max="50" id="Transactions_0__RecipientBankMailStop" maxlength="50" name="Transactions[0].RecipientBankMailStop" type="text" value="">
<div class="val-error" id="Transactions_0__RecipientBankMailStop_error"></div>
</fieldset>
<fieldset class="noborder t0 t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientBankCity">Recipient Bank City: </label><input data-ordinal="1140"
aria-errormessage="Transactions_0__RecipientBankCity_error" class="usa-input inline" data-val="true" data-val-length="The Recipient Bank City for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__RecipientBankCity" maxlength="50" name="Transactions[0].RecipientBankCity" type="text" value="">
<div class="val-error" id="Transactions_0__RecipientBankCity_error"></div>
</fieldset>
<fieldset class="noborder t0 t1 t2 t3 t4 t8 fieldset-contingent" data-ordinal="1150" data-target="Transactions_0__RecipientBankStateFields" data-target-value="USA" disabled="">
<label class="usa-label inline" for="Transactions_0__RecipientBankCountry">Recipient Bank Country: </label>
<select class="usa-select inline" aria-errormessage="Transactions_0__RecipientBankCountryError" id="Transactions_0__RecipientBankCountry" name="Transactions[0].RecipientBankCountry">
<option value="">[None]</option>
<optgroup label="">
<option value="USA">United States of America</option>
<option value="AFG">Afghanistan</option>
<option value="ALA">Åland Islands</option>
<option value="ALB">Albania</option>
<option value="DZA">Algeria</option>
<option value="AND">Andorra</option>
<option value="AGO">Angola</option>
<option value="AIA">Anguilla</option>
<option value="ATA">Antarctica</option>
<option value="ATG">Antigua and Barbuda</option>
<option value="ARG">Argentina</option>
<option value="ARM">Armenia</option>
<option value="ABW">Aruba</option>
<option value="AUS">Australia</option>
<option value="AUT">Austria</option>
<option value="AZE">Azerbaijan</option>
<option value="BHS">Bahamas</option>
<option value="BHR">Bahrain</option>
<option value="BGD">Bangladesh</option>
<option value="BRB">Barbados</option>
<option value="BLR">Belarus</option>
<option value="BEL">Belgium</option>
<option value="BLZ">Belize</option>
<option value="BEN">Benin</option>
<option value="BMU">Bermuda</option>
<option value="BTN">Bhutan</option>
<option value="BOL">Bolivia (Plurinational State of)</option>
<option value="BES">Bonaire, Sint Eustatius and Saba</option>
<option value="BIH">Bosnia and Herzegovina</option>
<option value="BWA">Botswana</option>
<option value="BVT">Bouvet Island</option>
<option value="BRA">Brazil</option>
<option value="IOT">British Indian Ocean Territory</option>
<option value="BRN">Brunei Darussalam</option>
<option value="BGR">Bulgaria</option>
<option value="BFA">Burkina Faso</option>
<option value="BDI">Burundi</option>
<option value="CPV">Cabo Verde</option>
<option value="KHM">Cambodia</option>
<option value="CMR">Cameroon</option>
<option value="CAN">Canada</option>
<option value="CYM">Cayman Islands</option>
<option value="CAF">Central African Republic</option>
<option value="TCD">Chad</option>
<option value="CHL">Chile</option>
<option value="CHN">China</option>
<option value="CXR">Christmas Island</option>
<option value="CCK">Cocos (Keeling) Islands</option>
<option value="COL">Colombia</option>
<option value="COM">Comoros</option>
<option value="COG">Congo</option>
<option value="COD">Congo (Democratic Republic of the)</option>
<option value="COK">Cook Islands</option>
<option value="CRI">Costa Rica</option>
<option value="CIV">Côte d'Ivoire</option>
<option value="HRV">Croatia</option>
<option value="CUB">Cuba</option>
<option value="CUW">Curaçao</option>
<option value="CYP">Cyprus</option>
<option value="CZE">Czech Republic</option>
<option value="DNK">Denmark</option>
<option value="DJI">Djibouti</option>
<option value="DMA">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="ECU">Ecuador</option>
<option value="EGY">Egypt</option>
<option value="SLV">El Salvador</option>
<option value="GNQ">Equatorial Guinea</option>
<option value="ERI">Eritrea</option>
<option value="EST">Estonia</option>
<option value="ETH">Ethiopia</option>
<option value="FLK">Falkland Islands (Malvinas)</option>
<option value="FRO">Faroe Islands</option>
<option value="FJI">Fiji</option>
<option value="FIN">Finland</option>
<option value="FRA">France</option>
<option value="GUF">French Guiana</option>
<option value="PYF">French Polynesia</option>
<option value="ATF">French Southern Territories</option>
<option value="GAB">Gabon</option>
<option value="GMB">Gambia</option>
<option value="GEO">Georgia</option>
<option value="DEU">Germany</option>
<option value="GHA">Ghana</option>
<option value="GIB">Gibraltar</option>
<option value="GRC">Greece</option>
<option value="GRL">Greenland</option>
<option value="GRD">Grenada</option>
<option value="GLP">Guadeloupe</option>
<option value="GTM">Guatemala</option>
<option value="GGY">Guernsey</option>
<option value="GIN">Guinea</option>
<option value="GNB">Guinea-Bissau</option>
<option value="GUY">Guyana</option>
<option value="HTI">Haiti</option>
<option value="HMD">Heard Island and McDonald Islands</option>
<option value="VAT">Holy See</option>
<option value="HND">Honduras</option>
<option value="HKG">Hong Kong</option>
<option value="HUN">Hungary</option>
<option value="ISL">Iceland</option>
<option value="IND">India</option>
<option value="IDN">Indonesia</option>
<option value="IRN">Iran (Islamic Republic of)</option>
<option value="IRQ">Iraq</option>
<option value="IRL">Ireland</option>
<option value="IMN">Isle of Man</option>
<option value="ISR">Israel</option>
<option value="ITA">Italy</option>
<option value="JAM">Jamaica</option>
<option value="JPN">Japan</option>
<option value="JEY">Jersey</option>
<option value="JOR">Jordan</option>
<option value="KAZ">Kazakhstan</option>
<option value="KEN">Kenya</option>
<option value="KIR">Kiribati</option>
<option value="PRK">Korea (Democratic People's Republic of)</option>
<option value="KOR">Korea (Republic of)</option>
<option value="KWT">Kuwait</option>
<option value="KGZ">Kyrgyzstan</option>
<option value="LAO">Lao People's Democratic Republic</option>
<option value="LVA">Latvia</option>
<option value="LBN">Lebanon</option>
<option value="LSO">Lesotho</option>
<option value="LBR">Liberia</option>
<option value="LBY">Libya</option>
<option value="LIE">Liechtenstein</option>
<option value="LTU">Lithuania</option>
<option value="LUX">Luxembourg</option>
<option value="MAC">Macao</option>
<option value="MDG">Madagascar</option>
<option value="MWI">Malawi</option>
<option value="MYS">Malaysia</option>
<option value="MDV">Maldives</option>
<option value="MLI">Mali</option>
<option value="MLT">Malta</option>
<option value="MHL">Marshall Islands</option>
<option value="MTQ">Martinique</option>
<option value="MRT">Mauritania</option>
<option value="MUS">Mauritius</option>
<option value="MYT">Mayotte</option>
<option value="MEX">Mexico</option>
<option value="FSM">Micronesia (Federated States of)</option>
<option value="MDA">Moldova (Republic of)</option>
<option value="MCO">Monaco</option>
<option value="MNG">Mongolia</option>
<option value="MNE">Montenegro</option>
<option value="MSR">Montserrat</option>
<option value="MAR">Morocco</option>
<option value="MOZ">Mozambique</option>
<option value="MMR">Myanmar</option>
<option value="NAM">Namibia</option>
<option value="NRU">Nauru</option>
<option value="NPL">Nepal</option>
<option value="NLD">Netherlands</option>
<option value="NCL">New Caledonia</option>
<option value="NZL">New Zealand</option>
<option value="NIC">Nicaragua</option>
<option value="NER">Niger</option>
<option value="NGA">Nigeria</option>
<option value="NIU">Niue</option>
<option value="NFK">Norfolk Island</option>
<option value="MKD">North Macedonia</option>
<option value="NOR">Norway</option>
<option value="OMN">Oman</option>
<option value="PAK">Pakistan</option>
<option value="PLW">Palau</option>
<option value="PSE">Palestinian Territory, Occupied</option>
<option value="PAN">Panama</option>
<option value="PNG">Papua New Guinea</option>
<option value="PRY">Paraguay</option>
<option value="PER">Peru</option>
<option value="PHL">Philippines</option>
<option value="PCN">Pitcairn</option>
<option value="POL">Poland</option>
<option value="PRT">Portugal</option>
<option value="QAT">Qatar</option>
<option value="REU">Réunion</option>
<option value="ROU">Romania</option>
<option value="RUS">Russian Federation</option>
<option value="RWA">Rwanda</option>
<option value="BLM">Saint Barthélemy</option>
<option value="SHN">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KNA">Saint Kitts and Nevis</option>
<option value="LCA">Saint Lucia</option>
<option value="MAF">Saint Martin (French part)</option>
<option value="SPM">Saint Pierre and Miquelon</option>
<option value="VCT">Saint Vincent and the Grenadines</option>
<option value="WSM">Samoa</option>
<option value="SMR">San Marino</option>
<option value="STP">Sao Tome and Principe</option>
<option value="SAU">Saudi Arabia</option>
<option value="SEN">Senegal</option>
<option value="SRB">Serbia</option>
<option value="SYC">Seychelles</option>
<option value="SLE">Sierra Leone</option>
<option value="SGP">Singapore</option>
<option value="SXM">Sint Maarten (Dutch part)</option>
<option value="SVK">Slovakia</option>
<option value="SVN">Slovenia</option>
<option value="SLB">Solomon Islands</option>
<option value="SOM">Somalia</option>
<option value="ZAF">South Africa</option>
<option value="SGS">South Georgia and the South Sandwich Islands</option>
<option value="SSD">South Sudan</option>
<option value="ESP">Spain</option>
<option value="LKA">Sri Lanka</option>
<option value="SDN">Sudan</option>
<option value="SUR">Suriname</option>
<option value="SJM">Svalbard and Jan Mayen</option>
<option value="SWZ">Swaziland</option>
<option value="SWE">Sweden</option>
<option value="CHE">Switzerland</option>
<option value="SYR">Syrian Arab Republic</option>
<option value="TWN">Taiwan</option>
<option value="TJK">Tajikistan</option>
<option value="TZA">Tanzania, United Republic of</option>
<option value="THA">Thailand</option>
<option value="TLS">Timor-Leste</option>
<option value="TGO">Togo</option>
<option value="TKL">Tokelau</option>
<option value="TON">Tonga</option>
<option value="TTO">Trinidad and Tobago</option>
<option value="TUN">Tunisia</option>
<option value="TUR">Turkey</option>
<option value="TKM">Turkmenistan</option>
<option value="TCA">Turks and Caicos Islands</option>
<option value="TUV">Tuvalu</option>
<option value="UGA">Uganda</option>
<option value="UKR">Ukraine</option>
<option value="ARE">United Arab Emirates</option>
<option value="GBR">United Kingdom</option>
<option value="USA">United States of America</option>
<option value="URY">Uruguay</option>
<option value="UZB">Uzbekistan</option>
<option value="VUT">Vanuatu</option>
<option value="VEN">Venezuela (Bolivarian Republic of)</option>
<option value="VNM">Viet Nam</option>
<option value="VGB">Virgin Islands (British)</option>
<option value="WLF">Wallis and Futuna</option>
<option value="ESH">Western Sahara</option>
<option value="YEM">Yemen</option>
<option value="ZMB">Zambia</option>
<option value="ZWE">Zimbabwe</option>
</optgroup>
</select>
<div class="val-error" id="Transactions_0__RecipientBankCountryError"></div>
</fieldset>
<fieldset id="Transactions_0__RecipientBankStateFields" data-ordinal="1155" class="state noborder t0 t1 t2 t3 t4 t8 fieldset-contingent" disabled="">
<label class="usa-label inline" for="Transactions_0__RecipientBankState">Recipient Bank State: </label>
<select class="usa-select inline" aria-errormessage="Transactions_0__RecipientBankStateError" id="Transactions_0__RecipientBankState" name="Transactions[0].RecipientBankState">
<option value="">[None]</option>
<optgroup label="">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</optgroup>
</select>
<div class="val-error" id="Transactions_0__RecipientBankStateError"></div>
</fieldset>
<fieldset class="noborder label-sm t0 t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientBankZipCode">Recipient Bank Zip Code/Route: </label><input data-ordinal="1160"
aria-errormessage="Transactions_0__RecipientBankZipCode_error" class="usa-input inline" data-val="true" data-val-length="The Recipient Bank Zip Code for transaction #1 must be no longer than 20 characters." data-val-length-max="20"
id="Transactions_0__RecipientBankZipCode" maxlength="20" name="Transactions[0].RecipientBankZipCode" type="text" value="">
<div class="val-error" id="Transactions_0__RecipientBankZipCode_error"></div>
</fieldset>
<fieldset class="noborder t1 t2 t3 t4 t7 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientAccountName">Recipient Name on Account: </label><input data-ordinal="1170"
aria-errormessage="Transactions_0__RecipientAccountName_error" class="usa-input inline" data-val="true" data-val-length="The Recipient Account Name for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__RecipientAccountName" maxlength="50" name="Transactions[0].RecipientAccountName" type="text" value="">
<div class="val-error" id="Transactions_0__RecipientAccountName_error"></div>
</fieldset>
<fieldset class="noborder t5 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientName">Recipient Name: </label><input data-ordinal="1170" aria-errormessage="Transactions_0__RecipientName_error"
class="usa-input inline" data-val="true" data-val-length="The Recipient Name for transaction #1 must be no longer than 50 characters." data-val-length-max="50" id="Transactions_0__RecipientName" maxlength="50"
name="Transactions[0].RecipientName" type="text" value="">
<div class="val-error" id="Transactions_0__RecipientName_error"></div>
</fieldset>
<fieldset class="noborder label-sm t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientBankRoutingNumber">Recipient Bank Routing Number: </label><input
class="route-num usa-input inline margin-right-05" data-ordinal="1180" aria-errormessage="Transactions_0__RecipientBankRoutingNumber_error" data-val="true"
data-val-length="The Recipient Routing Number for transaction #1 must be no longer than 50 characters." data-val-length-max="50" id="Transactions_0__RecipientBankRoutingNumber" maxlength="50"
name="Transactions[0].RecipientBankRoutingNumber" type="text"
value=""><a class="ic3-open-modal" href="#" aria-controls="tRoutingNumDef" aria-label="Get the definition of routing number" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a>
<div class="val-error" id="Transactions_0__RecipientBankRoutingNumber_error"></div>
</fieldset>
<fieldset class="noborder t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientAccountNumber">Recipient Account Number: </label><input data-ordinal="1190"
aria-errormessage="Transactions_0__RecipientAccountNumber_error" class="usa-input inline" data-val="true" data-val-length="The Recipient Account Number for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__RecipientAccountNumber" maxlength="50" name="Transactions[0].RecipientAccountNumber" type="text" value="">
<div class="val-error" id="Transactions_0__RecipientAccountNumber_error"></div>
</fieldset>
<fieldset class="noborder t6 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientAccountWallet">Recipient Wallet Address: </label><input class="cc-recip-wallet usa-input inline margin-right-05"
data-ordinal="1190" aria-errormessage="Transactions_0__RecipientAccountWallet_error" data-val="true" data-val-length="The Recipient Account/Wallet for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__RecipientAccountWallet" maxlength="50" name="Transactions[0].RecipientAccountWallet" type="text"
value=""><a class="ic3-open-modal" href="#" aria-controls="cryptoCurrencyRecipAddressDef" aria-label="Get help with the definition of cryptocurrency recipient wallet address" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a>
<div class="val-error" id="Transactions_0__RecipientAccountWallet_error"></div>
</fieldset>
<fieldset class="noborder t7 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientAccountIdentifier">Recipient Account Identifier: </label><input
class="transaction-account-num usa-input inline margin-right-05" data-ordinal="1190" aria-errormessage="Transactions_0__RecipientAccountIdentifier_error" data-val="true"
data-val-length="The Recipient Account Identifier for transaction #1 must be no longer than 50 characters." data-val-length-max="50" id="Transactions_0__RecipientAccountIdentifier" maxlength="50"
name="Transactions[0].RecipientAccountIdentifier" type="text"
value=""><a class="ic3-open-modal" href="#" aria-controls="p2pAccountIdDef" aria-label="Get help with the definition of P2P account identifier" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a>
<div class="val-error" id="Transactions_0__RecipientAccountIdentifier_error"></div>
</fieldset>
<fieldset class="noborder label-sm t5 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientIdentifier">Recipient Identifier (email/phone): </label><input data-ordinal="1190"
aria-errormessage="Transactions_0__RecipientIdentifier_error" class="usa-input inline" data-val="true" data-val-length="The Recipient Identifier for transaction #1 must be no longer than 50 characters." data-val-length-max="50"
id="Transactions_0__RecipientIdentifier" maxlength="50" name="Transactions[0].RecipientIdentifier" type="text" value="">
<div class="val-error" id="Transactions_0__RecipientIdentifier_error"></div>
</fieldset>
<fieldset class="noborder t1 t2 t3 t4 t8 fieldset-contingent" disabled=""><label class="usa-label inline" for="Transactions_0__RecipientBankSwiftCode">Recipient Bank SWIFT Code: </label><input
class="swift-num usa-input inline margin-right-05" pattern="[a-zA-Z]{6}\w{2}(\w{3})?" data-ordinal="1200" aria-errormessage="Transactions_0__RecipientBankSwiftCode_error" data-val="true"
data-val-length="The SWIFT Code for transaction #1 must be no longer than 50 characters." data-val-length-max="50" data-val-regex="The SWIFT Code for transaction #1 must be in a valid SWIFT Code format."
data-val-regex-pattern="[a-zA-Z]{6}\w{2}(\w{3})?" id="Transactions_0__RecipientBankSwiftCode" maxlength="50" name="Transactions[0].RecipientBankSwiftCode" type="text"
value=""><a class="ic3-open-modal" href="#" aria-controls="tSwiftDef" aria-label="Get the definition of SWIFT Code" role="button"><svg class="usa-icon" aria-hidden="true" focusable="false" role="img"><use href="img/sprite.svg#help"></use></svg></a>
<div class="val-error" id="Transactions_0__RecipientBankSwiftCode_error"></div>
</fieldset>
</details>
</div>
</div>
<div class="display-flex flex-justify-end width-full">
<button class="usa-button margin-top-1" type="submit" formaction="AddTransaction#step3">Add Transaction</button>
</div>
</div>
<div class="step-buttons"><button type="button" class="usa-button prev">Previous (step 2)</button>
<div aria-hidden="true"> </div><button type="button" class="usa-button next">Next (step 4)</button>
</div>
</article>
<article id="step4" class="form-step display-none" data-step-num="4" aria-hidden="true">
<fieldset class="usa-fieldset">
<legend class="text-semibold border-bottom font-sans-lg width-full usa-legend usa-label">Information About The Subject(s)</legend>
<aside class="text-italic">Please complete one section for each subject that caused this incident. <span class="text-underline">If you do not have all of the requested information, please provide as much as possible.</span> If subject(s) are
not known, proceed to the next section.</aside>
<div class="subjects usa-accordion usa-accordion--bordered usa-accordion--multiselectable margin-y-3" data-allow-multiple="">
<div data-index="1">
<div class="usa-accordion__heading">
<button type="button" class="usa-accordion__button" aria-controls="subject0" aria-expanded="true">
<div>Subject #1</div>
</button>
</div>
<div class="usa-accordion__content" id="subject0">
<button class="float-right usa-button" type="submit" name="Subject" formaction="RemoveSubject#step4" value="0">Remove Subject</button>
<fieldset class="noborder"><label class="usa-label inline" for="Subjects_0__Name">Name: </label><input aria-errormessage="Subjects_0__Name_error" class="usa-input inline" data-val="true"
data-val-length="The Name for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Subjects_0__Name" maxlength="50" name="Subjects[0].Name" type="text" value="">
<div class="val-error" id="Subjects_0__Name_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Subjects_0__BusinessName">Business Name: </label><input aria-errormessage="Subjects_0__BusinessName_error" class="usa-input inline" data-val="true"
data-val-length="The Business Name for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Subjects_0__BusinessName" maxlength="50" name="Subjects[0].BusinessName" type="text" value="">
<div class="val-error" id="Subjects_0__BusinessName_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Subjects_0__Address1">Address: </label><input aria-errormessage="Subjects_0__Address1_error" class="usa-input inline" data-val="true"
data-val-length="The Address for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Subjects_0__Address1" maxlength="50" name="Subjects[0].Address1" type="text" value="">
<div class="val-error" id="Subjects_0__Address1_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Subjects_0__Address2">Address (continued): </label><input aria-errormessage="Subjects_0__Address2_error" class="usa-input inline" data-val="true"
data-val-length="The Address (cont.) for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Subjects_0__Address2" maxlength="50" name="Subjects[0].Address2" type="text" value="">
<div class="val-error" id="Subjects_0__Address2_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Subjects_0__MailStop">Suite/Apt./Mail Stop: </label><input aria-errormessage="Subjects_0__MailStop_error" class="usa-input inline" data-val="true"
data-val-length="The Suite/Apt./MailStop for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Subjects_0__MailStop" maxlength="50" name="Subjects[0].MailStop" type="text" value="">
<div class="val-error" id="Subjects_0__MailStop_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Subjects_0__City">City: </label><input aria-errormessage="Subjects_0__City_error" class="usa-input inline" data-val="true"
data-val-length="The City for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Subjects_0__City" maxlength="50" name="Subjects[0].City" type="text" value="">
<div class="val-error" id="Subjects_0__City_error"></div>
</fieldset>
<fieldset class="noborder" data-target="Subjects_0_StateField" data-target-value="USA">
<label class="usa-label inline" for="Subjects_0__Country">Country: </label>
<select class="usa-select inline" aria-errormessage="Subjects_0__CountryError" id="Subjects_0__Country" name="Subjects[0].Country">
<option value="">[None/Unknown]</option>
<optgroup label="">
<option value="USA">United States of America</option>
<option value="AFG">Afghanistan</option>
<option value="ALA">Åland Islands</option>
<option value="ALB">Albania</option>
<option value="DZA">Algeria</option>
<option value="AND">Andorra</option>
<option value="AGO">Angola</option>
<option value="AIA">Anguilla</option>
<option value="ATA">Antarctica</option>
<option value="ATG">Antigua and Barbuda</option>
<option value="ARG">Argentina</option>
<option value="ARM">Armenia</option>
<option value="ABW">Aruba</option>
<option value="AUS">Australia</option>
<option value="AUT">Austria</option>
<option value="AZE">Azerbaijan</option>
<option value="BHS">Bahamas</option>
<option value="BHR">Bahrain</option>
<option value="BGD">Bangladesh</option>
<option value="BRB">Barbados</option>
<option value="BLR">Belarus</option>
<option value="BEL">Belgium</option>
<option value="BLZ">Belize</option>
<option value="BEN">Benin</option>
<option value="BMU">Bermuda</option>
<option value="BTN">Bhutan</option>
<option value="BOL">Bolivia (Plurinational State of)</option>
<option value="BES">Bonaire, Sint Eustatius and Saba</option>
<option value="BIH">Bosnia and Herzegovina</option>
<option value="BWA">Botswana</option>
<option value="BVT">Bouvet Island</option>
<option value="BRA">Brazil</option>
<option value="IOT">British Indian Ocean Territory</option>
<option value="BRN">Brunei Darussalam</option>
<option value="BGR">Bulgaria</option>
<option value="BFA">Burkina Faso</option>
<option value="BDI">Burundi</option>
<option value="CPV">Cabo Verde</option>
<option value="KHM">Cambodia</option>
<option value="CMR">Cameroon</option>
<option value="CAN">Canada</option>
<option value="CYM">Cayman Islands</option>
<option value="CAF">Central African Republic</option>
<option value="TCD">Chad</option>
<option value="CHL">Chile</option>
<option value="CHN">China</option>
<option value="CXR">Christmas Island</option>
<option value="CCK">Cocos (Keeling) Islands</option>
<option value="COL">Colombia</option>
<option value="COM">Comoros</option>
<option value="COG">Congo</option>
<option value="COD">Congo (Democratic Republic of the)</option>
<option value="COK">Cook Islands</option>
<option value="CRI">Costa Rica</option>
<option value="CIV">Côte d'Ivoire</option>
<option value="HRV">Croatia</option>
<option value="CUB">Cuba</option>
<option value="CUW">Curaçao</option>
<option value="CYP">Cyprus</option>
<option value="CZE">Czech Republic</option>
<option value="DNK">Denmark</option>
<option value="DJI">Djibouti</option>
<option value="DMA">Dominica</option>
<option value="DOM">Dominican Republic</option>
<option value="ECU">Ecuador</option>
<option value="EGY">Egypt</option>
<option value="SLV">El Salvador</option>
<option value="GNQ">Equatorial Guinea</option>
<option value="ERI">Eritrea</option>
<option value="EST">Estonia</option>
<option value="ETH">Ethiopia</option>
<option value="FLK">Falkland Islands (Malvinas)</option>
<option value="FRO">Faroe Islands</option>
<option value="FJI">Fiji</option>
<option value="FIN">Finland</option>
<option value="FRA">France</option>
<option value="GUF">French Guiana</option>
<option value="PYF">French Polynesia</option>
<option value="ATF">French Southern Territories</option>
<option value="GAB">Gabon</option>
<option value="GMB">Gambia</option>
<option value="GEO">Georgia</option>
<option value="DEU">Germany</option>
<option value="GHA">Ghana</option>
<option value="GIB">Gibraltar</option>
<option value="GRC">Greece</option>
<option value="GRL">Greenland</option>
<option value="GRD">Grenada</option>
<option value="GLP">Guadeloupe</option>
<option value="GTM">Guatemala</option>
<option value="GGY">Guernsey</option>
<option value="GIN">Guinea</option>
<option value="GNB">Guinea-Bissau</option>
<option value="GUY">Guyana</option>
<option value="HTI">Haiti</option>
<option value="HMD">Heard Island and McDonald Islands</option>
<option value="VAT">Holy See</option>
<option value="HND">Honduras</option>
<option value="HKG">Hong Kong</option>
<option value="HUN">Hungary</option>
<option value="ISL">Iceland</option>
<option value="IND">India</option>
<option value="IDN">Indonesia</option>
<option value="IRN">Iran (Islamic Republic of)</option>
<option value="IRQ">Iraq</option>
<option value="IRL">Ireland</option>
<option value="IMN">Isle of Man</option>
<option value="ISR">Israel</option>
<option value="ITA">Italy</option>
<option value="JAM">Jamaica</option>
<option value="JPN">Japan</option>
<option value="JEY">Jersey</option>
<option value="JOR">Jordan</option>
<option value="KAZ">Kazakhstan</option>
<option value="KEN">Kenya</option>
<option value="KIR">Kiribati</option>
<option value="PRK">Korea (Democratic People's Republic of)</option>
<option value="KOR">Korea (Republic of)</option>
<option value="KWT">Kuwait</option>
<option value="KGZ">Kyrgyzstan</option>
<option value="LAO">Lao People's Democratic Republic</option>
<option value="LVA">Latvia</option>
<option value="LBN">Lebanon</option>
<option value="LSO">Lesotho</option>
<option value="LBR">Liberia</option>
<option value="LBY">Libya</option>
<option value="LIE">Liechtenstein</option>
<option value="LTU">Lithuania</option>
<option value="LUX">Luxembourg</option>
<option value="MAC">Macao</option>
<option value="MDG">Madagascar</option>
<option value="MWI">Malawi</option>
<option value="MYS">Malaysia</option>
<option value="MDV">Maldives</option>
<option value="MLI">Mali</option>
<option value="MLT">Malta</option>
<option value="MHL">Marshall Islands</option>
<option value="MTQ">Martinique</option>
<option value="MRT">Mauritania</option>
<option value="MUS">Mauritius</option>
<option value="MYT">Mayotte</option>
<option value="MEX">Mexico</option>
<option value="FSM">Micronesia (Federated States of)</option>
<option value="MDA">Moldova (Republic of)</option>
<option value="MCO">Monaco</option>
<option value="MNG">Mongolia</option>
<option value="MNE">Montenegro</option>
<option value="MSR">Montserrat</option>
<option value="MAR">Morocco</option>
<option value="MOZ">Mozambique</option>
<option value="MMR">Myanmar</option>
<option value="NAM">Namibia</option>
<option value="NRU">Nauru</option>
<option value="NPL">Nepal</option>
<option value="NLD">Netherlands</option>
<option value="NCL">New Caledonia</option>
<option value="NZL">New Zealand</option>
<option value="NIC">Nicaragua</option>
<option value="NER">Niger</option>
<option value="NGA">Nigeria</option>
<option value="NIU">Niue</option>
<option value="NFK">Norfolk Island</option>
<option value="MKD">North Macedonia</option>
<option value="NOR">Norway</option>
<option value="OMN">Oman</option>
<option value="PAK">Pakistan</option>
<option value="PLW">Palau</option>
<option value="PSE">Palestinian Territory, Occupied</option>
<option value="PAN">Panama</option>
<option value="PNG">Papua New Guinea</option>
<option value="PRY">Paraguay</option>
<option value="PER">Peru</option>
<option value="PHL">Philippines</option>
<option value="PCN">Pitcairn</option>
<option value="POL">Poland</option>
<option value="PRT">Portugal</option>
<option value="QAT">Qatar</option>
<option value="REU">Réunion</option>
<option value="ROU">Romania</option>
<option value="RUS">Russian Federation</option>
<option value="RWA">Rwanda</option>
<option value="BLM">Saint Barthélemy</option>
<option value="SHN">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KNA">Saint Kitts and Nevis</option>
<option value="LCA">Saint Lucia</option>
<option value="MAF">Saint Martin (French part)</option>
<option value="SPM">Saint Pierre and Miquelon</option>
<option value="VCT">Saint Vincent and the Grenadines</option>
<option value="WSM">Samoa</option>
<option value="SMR">San Marino</option>
<option value="STP">Sao Tome and Principe</option>
<option value="SAU">Saudi Arabia</option>
<option value="SEN">Senegal</option>
<option value="SRB">Serbia</option>
<option value="SYC">Seychelles</option>
<option value="SLE">Sierra Leone</option>
<option value="SGP">Singapore</option>
<option value="SXM">Sint Maarten (Dutch part)</option>
<option value="SVK">Slovakia</option>
<option value="SVN">Slovenia</option>
<option value="SLB">Solomon Islands</option>
<option value="SOM">Somalia</option>
<option value="ZAF">South Africa</option>
<option value="SGS">South Georgia and the South Sandwich Islands</option>
<option value="SSD">South Sudan</option>
<option value="ESP">Spain</option>
<option value="LKA">Sri Lanka</option>
<option value="SDN">Sudan</option>
<option value="SUR">Suriname</option>
<option value="SJM">Svalbard and Jan Mayen</option>
<option value="SWZ">Swaziland</option>
<option value="SWE">Sweden</option>
<option value="CHE">Switzerland</option>
<option value="SYR">Syrian Arab Republic</option>
<option value="TWN">Taiwan</option>
<option value="TJK">Tajikistan</option>
<option value="TZA">Tanzania, United Republic of</option>
<option value="THA">Thailand</option>
<option value="TLS">Timor-Leste</option>
<option value="TGO">Togo</option>
<option value="TKL">Tokelau</option>
<option value="TON">Tonga</option>
<option value="TTO">Trinidad and Tobago</option>
<option value="TUN">Tunisia</option>
<option value="TUR">Turkey</option>
<option value="TKM">Turkmenistan</option>
<option value="TCA">Turks and Caicos Islands</option>
<option value="TUV">Tuvalu</option>
<option value="UGA">Uganda</option>
<option value="UKR">Ukraine</option>
<option value="ARE">United Arab Emirates</option>
<option value="GBR">United Kingdom</option>
<option value="USA">United States of America</option>
<option value="URY">Uruguay</option>
<option value="UZB">Uzbekistan</option>
<option value="VUT">Vanuatu</option>
<option value="VEN">Venezuela (Bolivarian Republic of)</option>
<option value="VNM">Viet Nam</option>
<option value="VGB">Virgin Islands (British)</option>
<option value="WLF">Wallis and Futuna</option>
<option value="ESH">Western Sahara</option>
<option value="YEM">Yemen</option>
<option value="ZMB">Zambia</option>
<option value="ZWE">Zimbabwe</option>
</optgroup>
</select>
<div class="val-error" id="Subjects_0__CountryError"></div>
</fieldset>
<fieldset id="Subjects_0_StateField" class="noborder fieldset-contingent" disabled="">
<label class="usa-label inline" for="Subjects_0__State">State: </label>
<select class="usa-select inline" aria-errormessage="Subjects_0__StateError" id="Subjects_0__State" name="Subjects[0].State">
<option value="">[None/Unknown]</option>
<optgroup label="">
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</optgroup>
</select>
<div class="val-error" id="Subjects_0__StateError"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Subjects_0__ZipCode">Zip Code/Route: </label><input aria-errormessage="Subjects_0__ZipCode_error" class="usa-input inline" data-val="true"
data-val-length="The Zip Code for subject #1 must be no longer than 20 characters." data-val-length-max="20" id="Subjects_0__ZipCode" maxlength="20" name="Subjects[0].ZipCode" type="text" value="">
<div class="val-error" id="Subjects_0__ZipCode_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Subjects_0__Phone">Phone Number: </label><span class="usa-tooltip display-inline"><input type="tel" pattern="\d+" class="usa-input inline usa-tooltip__trigger"
data-position="right" data-classes="display-inline" data-field-type="Phone" aria-errormessage="Subjects_0__Phone_error" data-val="true" data-val-length="The Phone number for subject #1 must be no longer than 20 digits."
data-val-length-max="20" data-val-regex="The Phone number for subject #1 must be digits only. (ex. 1112223333)" data-val-regex-pattern="\d+" id="Subjects_0__Phone" maxlength="20" name="Subjects[0].Phone" value=""
aria-describedby="tooltip-340264" tabindex="0"><span class="usa-tooltip__body" id="tooltip-340264" role="tooltip" aria-hidden="true">Numbers only (1112223333)</span></span>
<div class="val-error" id="Subjects_0__Phone_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Subjects_0__Email">Email Address: </label><span class="usa-tooltip display-inline"><input type="email" class="usa-input inline usa-tooltip__trigger" data-position="right"
data-classes="display-inline" data-field-type="Email" aria-errormessage="Subjects_0__Email_error" data-val="true" data-val-emailaddress="The Email Address for subject #1 must be a valid email address."
data-val-length="The Email Address for subject #1 must be no longer than 50 characters." data-val-length-max="50" id="Subjects_0__Email" maxlength="50" name="Subjects[0].Email" value="" aria-describedby="tooltip-475826"
tabindex="0"><span class="usa-tooltip__body" id="tooltip-475826" role="tooltip" aria-hidden="true">Example: jdoe@email.com</span></span>
<div class="val-error" id="Subjects_0__Email_error"></div>
</fieldset>
<fieldset class="noborder label-sm"><label class="usa-label inline" for="Subjects_0__Website">Website/Social Media Account: </label><input inputmode="url" aria-errormessage="Subjects_0__Website_error" class="usa-input inline"
data-val="true" data-val-length="The Website Address/Social Media Account for subject #1 must be no longer than 100 characters." data-val-length-max="100" id="Subjects_0__Website" maxlength="100" name="Subjects[0].Website" type="text"
value="">
<div class="val-error" id="Subjects_0__Website_error"></div>
</fieldset>
<fieldset class="noborder"><label class="usa-label inline" for="Subjects_0__IPAddress">IP Address: </label><span class="usa-tooltip display-inline"><input class="usa-input inline usa-tooltip__trigger" data-position="right"
data-classes="display-inline"
pattern="(((((1\d|[1-9])?\d|2([0-4]\d|5[0-5]))\.){3}((1\d|[1-9])?\d|2([0-4]\d|5[0-5])))|((([0-9a-fA-F]{1,4}:){7,7}[0-9a-fA-F]{1,4}|([0-9a-fA-F]{1,4}:){1,7}:|([0-9a-fA-F]{1,4}:){1,6}:[0-9a-fA-F]{1,4}|([0-9a-fA-F]{1,4}:){1,5}(:[0-9a-fA-F]{1,4}){1,2}|([0-9a-fA-F]{1,4}:){1,4}(:[\da-fA-F]{1,4}){1,3}|([\da-fA-F]{1,4}:){1,3}(:[\da-fA-F]{1,4}){1,4}|([\da-fA-F]{1,4}:){1,2}(:[\da-fA-F]{1,4}){1,5}|[\da-fA-F]{1,4}:((:[\da-fA-F]{1,4}){1,6})|:((:[\da-fA-F]{1,4}){1,7}|:))))"
aria-errormessage="Subjects_0__IPAddress_error" data-val="true" data-val-ipaddress="The IP Address for subject #1 must be a valid IP address. (ex. 1.2.3.4 or 1111:2222::FFFF)"
data-val-length="The IP Address for subject #1 must be no longer than 39 characters." data-val-length-max="39" id="Subjects_0__IPAddress" maxlength="39" name="Subjects[0].IPAddress" type="text" value=""
aria-describedby="tooltip-631652" tabindex="0"><span class="usa-tooltip__body" id="tooltip-631652" role="tooltip" aria-hidden="true">123.45.67.89 or 2001:abc::1234</span></span>
<div class="val-error" id="Subjects_0__IPAddress_error"></div>
</fieldset>
</div>
</div>
<div class="display-flex flex-justify-end width-full">
<button class="usa-button margin-top-1" type="submit" formaction="AddSubject#step4">Add Subject</button>
</div>
</div>
</fieldset>
<div class="step-buttons"><button type="button" class="usa-button prev">Previous (step 3)</button>
<div aria-hidden="true"> </div><button type="button" class="usa-button next">Next (step 5)</button>
</div>
</article>
<article id="step5" class="form-step display-none" data-step-num="5" aria-hidden="true">
<fieldset class="usa-fieldset">
<legend class="text-semibold border-bottom font-sans-lg width-full usa-legend usa-label">Description of Incident</legend>
<div class="usa-alert usa-alert--warning usa-alert--slim">
<div class="usa-alert__body">
<p class="margin-0 usa-alert__text"> Law enforcement or regulatory agencies may desire copies of pertinent documents or other evidence regarding your complaint. Originals should be retained for use by law enforcement agencies. <strong>It is
not necessary to provide your evidence here.</strong>
</p>
</div>
</div>
<div class="usa-character-count padding-bottom-3" data-maxlength="3500">
<fieldset class="noborder width-full"><label class="usa-label" for="IncidentDescription"><abbr class="usa-hint--required" title="Required">*</abbr>Describe what happened in your own words. Provide any information you have yet to include in
this complaint that may assist law enforcement in understanding what happened.</label><textarea required="" aria-describedby="IncidentDescriptionCount" class="usa-character-count__field usa-textarea"
aria-errormessage="IncidentDescription_error" data-val="true" data-val-length="The Incident Description must be no longer than 3,500 characters." data-val-length-max="3500" data-val-required="Please provide an Incident Description."
id="IncidentDescription" name="IncidentDescription"></textarea>
<div class="val-error" id="IncidentDescription_error"></div>
</fieldset>
<div id="IncidentDescriptionCount" class="usa-character-count__message margin-bottom-1 usa-sr-only">Please limit responses to 3,500 characters</div>
<div class="usa-character-count__status usa-hint" aria-hidden="true">3500 characters allowed</div>
<div class="usa-character-count__sr-status usa-sr-only" aria-live="polite">3500 characters allowed</div>
</div>
</fieldset>
<div class="step-buttons"><button type="button" class="usa-button prev">Previous (step 4)</button>
<div aria-hidden="true"> </div><button type="button" class="usa-button next">Next (step 6)</button>
</div>
</article>
<article id="step6" class="form-step display-none" data-step-num="6" aria-hidden="true">
<fieldset class="usa-fieldset">
<legend class="text-semibold border-bottom font-sans-lg width-full usa-legend usa-label">Other Information</legend>
<div class="usa-character-count" data-maxlength="5000">
<fieldset class="noborder width-full"><label class="usa-label" for="EmailHeaders">Please provide any technical details regarding this incident. This can include email headers, cryptocurrency transaction metadata, ransomware hashes,
etc.</label><textarea aria-describedby="EmailHeadersCount" class="usa-character-count__field usa-textarea" aria-errormessage="EmailHeaders_error" data-val="true"
data-val-length="The Email Text and Headers must be no longer than 5,000 characters." data-val-length-max="5000" id="EmailHeaders" name="EmailHeaders"></textarea>
<div class="val-error" id="EmailHeaders_error"></div>
</fieldset>
<div id="EmailHeadersCount" class="usa-character-count__message margin-bottom-1 usa-sr-only">Please limit responses to 5,000 characters</div>
<div class="usa-character-count__status usa-hint" aria-hidden="true">5000 characters allowed</div>
<div class="usa-character-count__sr-status usa-sr-only" aria-live="polite">5000 characters allowed</div>
</div>
<div class="usa-character-count" data-maxlength="1000">
<fieldset class="noborder width-full"><label class="usa-label" for="Witnesses">Are there any other witnesses or persons affected by this incident?</label><textarea aria-describedby="WitnessesCount"
class="usa-character-count__field usa-textarea" aria-errormessage="Witnesses_error" data-val="true" data-val-length="The Other Witnesses or Victims must be no longer than 1,000 characters." data-val-length-max="1000" id="Witnesses"
name="Witnesses"></textarea>
<div class="val-error" id="Witnesses_error"></div>
</fieldset>
<div id="WitnessesCount" class="usa-character-count__message margin-bottom-1 usa-sr-only">Please limit responses to 1,000 characters</div>
<div class="usa-character-count__status usa-hint" aria-hidden="true">1000 characters allowed</div>
<div class="usa-character-count__sr-status usa-sr-only" aria-live="polite">1000 characters allowed</div>
</div>
<div class="usa-character-count" data-maxlength="1000">
<fieldset class="noborder width-full"><label class="usa-label" for="LawEnforcement">If you have reported this incident to other law enforcement or government agencies, please provide the name, phone number, email, date reported, report
number, etc.</label><textarea aria-describedby="LawEnforcementCount" class="usa-character-count__field usa-textarea" aria-errormessage="LawEnforcement_error" data-val="true"
data-val-length="The Other Law Enforcement or Agency Reports must be no longer than 1,000 characters." data-val-length-max="1000" id="LawEnforcement" name="LawEnforcement"></textarea>
<div class="val-error" id="LawEnforcement_error"></div>
</fieldset>
<div id="LawEnforcementCount" class="usa-character-count__message margin-bottom-1 usa-sr-only">Please limit responses to 1,000 characters</div>
<div class="usa-character-count__status usa-hint" aria-hidden="true">1000 characters allowed</div>
<div class="usa-character-count__sr-status usa-sr-only" aria-live="polite">1000 characters allowed</div>
</div>
<fieldset class="usa-fieldset margin-bottom-3">
<legend class="usa-legend usa-label">Is this an update to a previously filed complaint?</legend>
<div class="usa-radio"><input aria-errormessage="ComplaintUpdate_error" class="usa-radio__input" id="ComplaintUpdate_yes" name="ComplaintUpdate" type="radio" value="true"><label class="usa-radio__label"
for="ComplaintUpdate_yes">Yes</label><input aria-errormessage="ComplaintUpdate_error" class="usa-radio__input" id="ComplaintUpdate_no" name="ComplaintUpdate" type="radio" value="false"><label class="usa-radio__label"
for="ComplaintUpdate_no">No</label></div>
<div class="val-error" id="ComplaintUpdate_error"></div>
</fieldset>
</fieldset>
<div class="step-buttons"><button type="button" class="usa-button prev">Previous (step 5)</button>
<div aria-hidden="true"> </div><button type="button" class="usa-button next">Next (step 7)</button>
</div>
</article>
<article id="step7" class="form-step display-none" data-step-num="7" aria-hidden="true">
<fieldset class="usa-fieldset">
<legend class="text-semibold border-bottom font-sans-lg width-full usa-legend usa-label">Privacy & Signature</legend>
<p class="text-bold">Read the following statement below, and confirm your agreement by typing your full name below in the box provided:</p>
<p>The collection of information on this form is authorized by one or more of the following statutes: <cite>18 U.S.C. § 1028</cite> (false documents and identity theft); <cite>1028A</cite> (aggravated identity theft); <cite>18 U.S.C. §
1029</cite> (credit card fraud); <cite>18 U.S.C. § 1030</cite> (computer fraud); <cite>18 U.S.C. § 1343</cite> (wire fraud); <cite>18 U.S.C 2318B</cite> (counterfeit and illicit labels); <cite>18 U.S.C. § 2319</cite> (violation of
intellectual property rights); <cite>28 U.S.C. § 533</cite> (FBI authorized to investigate violations of federal law for which it has primary investigative jurisdiction); and <cite>28 U.S.C. § 534</cite> (FBI authorized to collect and
maintain identification, criminal information, crime, and other records).</p>
<p>The collection of this information is relevant and necessary to document and investigate complaints of Internet-related crime. Submission of the information requested is voluntary; however, your failure to supply requested information may
impede or preclude the investigation of your complaint by law enforcement agencies.</p>
<p>The information collected is maintained in one or more of the following Privacy Act Systems of Records: the FBI Central Records System, Justice/FBI-002, notice of which was published in the Federal Register at <cite>63 Fed. Reg. 8671 (Feb.
20, 1998)</cite>; the FBI Data Warehouse System, DOJ/FBI-022, notice of which was published in the Federal Register at <cite>77 Fed. Reg. 40631 (July 10, 2012)</cite>. Descriptions of these systems may also be found at
<a target="_blank" href="https://www.justice.gov/opcl/doj-systems-records#FBI">www.justice.gov/opcl/doj-systems-records#FBI</a>. The information collected may be disclosed in accordance with the routine uses referenced in those notices or as
otherwise permitted by law. For example, in accordance with those routine uses, in certain circumstances, the FBI may disclose information from your complaint to appropriate criminal, civil, or regulatory law enforcement authorities (whether
federal, state, local, territorial, tribal, foreign, or international). Information also may be disclosed as a routine use to an organization or individual in both the public or private sector if deemed necessary to elicit information or
cooperation from the recipient for use by the FBI in the performance of an authorized activity. "An example would be where the activities of an individual are disclosed to a member of the public in order to elicit his/her assistance in
[FBI's] apprehension or detection efforts." <cite>63 Fed. Reg. 8671, 8682 (February 20, 1998)</cite>.</p>
<p class="text-bold">By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature. I affirm that the information I provided is true and accurate to the best of
my knowledge. I understand that providing false information could make me subject to fine, imprisonment, or both. (Title 18, U.S.Code, Section 1001)</p>
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class="usa-input inline" data-val="true" data-val-length="The Digital Signature must be no longer than 50 characters." data-val-length-max="50" data-val-required="Please provide a Digital Signature." id="DigitalSignature" maxlength="50"
name="DigitalSignature" type="text" value="">
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Search
1. Who is Filing this Complaint?Who is Filing this Complaint?
2. Complainant InformationComplainant Information
3. Financial Transaction(s)Financial Transaction(s)
4. Information About The Subject(s)Information About The Subject(s)
5. Description of IncidentDescription of Incident
6. Other InformationOther Information
7. Privacy & SignaturePrivacy & Signature
* A red asterisk (*) indicates a required field.
* All other fields are optional. Please provide all requested information if
possible, but these fields may be left blank.
* Do not not provide complainant Personally Identifiable Information (PII) such
as Social Security numbers or dates of birth anywhere in this form.
Who is Filing this Complaint?
If you were the one affected by this incident, please indicate so below. In the
event that you are completing this form on behalf of another individual or
business, please select NO and provide your contact information.
*Were you the one affected in this incident?
Yes No
Your Contact Information
If you are the one affected by this incident, the information below will be
transferred to the Complainant section.
*Name:
Business Name:
*Phone Number: Numbers only (1112223333)
*Email Address: Example: jdoe@email.com
Next (step 2)
Complainant Information
Please provide as much detail as possible related to the one affected by this
incident. If you are reporting on behalf of a business, please include any
Points-of-Contact (POCs) at the business in the section below.
*Name:
Age: Please select one... Under 20 20 - 29 30 - 39 40 - 49 50 - 59 Over 60
*Is the complainant 17 years old or younger?
Yes No
*Address:
Address (continued):
Suite/Apt./Mail Stop:
*City:
County:
*Country: Please select one... United States of America Afghanistan Åland
Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda
Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh
Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational
State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana
Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria
Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central
African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands
Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa
Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti
Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea
Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France
French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia
Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey
Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See
Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of)
Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan
Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of)
Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho
Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi
Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius
Mayotte Mexico Micronesia (Federated States of) Moldova (Republic of) Monaco
Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal
Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk
Island North Macedonia Norway Oman Pakistan Palau Palestinian Territory,
Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland
Portugal Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint
Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint
Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines
Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles
Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon
Islands Somalia South Africa South Georgia and the South Sandwich Islands South
Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden
Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of
Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey
Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates
United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela
(Bolivarian Republic of) Viet Nam Virgin Islands (British) Wallis and Futuna
Western Sahara Yemen Zambia Zimbabwe
*State: Please select one... Alabama Alaska American Samoa Arizona Arkansas
California Colorado Connecticut Delaware District of Columbia Florida Georgia
Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland
Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada
New Hampshire New Jersey New Mexico New York North Carolina North Dakota
Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode
Island South Carolina South Dakota Tennessee Texas United States Minor Outlying
Islands Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia
Wisconsin Wyoming
*Zip Code/Route:
*Phone Number: Numbers only (1112223333)
*Email Address: Example: jdoe@email.com
Business Information Is this on behalf of a business that was targeted by a
Cyber incident?
Yes No
*Business Name:
*Is the incident currently impacting business operations?
Yes No
If applicable, provide points of contact (POCs) for this business.
Business IT POC: Include Name, Email, Phone number, etc.
Other Business POC: Include Name, Email, Phone number, etc.
If your business or organization is defined as a critical infrastructure entity,
select the sector below: None/Unsure Chemical Commercial Facilities
Communications Critical Manufacturing Dams Defense Industrial Base Emergency
Services Energy Financial Services Food and Agriculture Government Facilities
Healthcare and Public Health Information Technology Nuclear Reactors, Materials,
& Waste Transportation Systems Water & Wastewater Systems
If known or applicable, please select the critical infrastructure subsector:
None/Unsure
Previous (step 1)
Next (step 3)
Financial Transaction(s) *Did you send or lose money in the incident?
Yes No
*What was your total loss amount?
For the transaction information below:
* Provide the most recent transactions involved with this incident.
* Specify all money amounts below in US Dollars (USD).
* Originating account refers to where the funds were sent from; usually the
Complainant's account.
* Recipient account refers to where the funds were sent to; usually a Subject's
account.
* More information about the types of transactions can be found by clicking the
help icon () next to the Transaction Type field.
Transaction #1
Remove Transaction Transaction Type: Please select one... Cash Check/Cashier's
Check Cryptocurrency/Crypto ATM Debit Card/Credit Card Money Order Other
Peer-to-peer Transfer Prepaid Card/Gift Card Wire Transfer
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Non-applicable fields (click to view)*If other, please specify:
*Was the money sent or lost?
Yes No
*Transaction Amount:
*Transaction Date:
Did you contact your bank, financial institution, or cryptocurrency exchange?
Yes No
--------------------------------------------------------------------------------
Originating Bank Name:
Type of Cryptocurrency:
P2P Application Used:
Type of Prepaid/Gift Card:
Originating Bank Address:
Transaction ID/Hash:
Originating Bank Address (cont.):
Cryptocurrency ATM/Kiosk:
Originating Bank Suite/Mail Stop:
ATM/Kiosk Address:
Originating Bank City:
ATM/Kiosk City:
ATM/Kiosk Country: [None] United States of America Afghanistan Åland Islands
Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina
Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados
Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of)
Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island
Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso
Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African
Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia
Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa Rica Côte
d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica
Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia
Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French
Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany
Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea
Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras
Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq
Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya
Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kuwait
Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya
Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives
Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico
Micronesia (Federated States of) Moldova (Republic of) Monaco Mongolia
Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands
New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North
Macedonia Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama
Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar
Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena,
Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin
(French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa
San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra
Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands
Somalia South Africa South Georgia and the South Sandwich Islands South Sudan
Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden
Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of
Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey
Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates
United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela
(Bolivarian Republic of) Viet Nam Virgin Islands (British) Wallis and Futuna
Western Sahara Yemen Zambia Zimbabwe
Originating Bank Country: [None] United States of America Afghanistan Åland
Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda
Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh
Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational
State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana
Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria
Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central
African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands
Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa
Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti
Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea
Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France
French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia
Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey
Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See
Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of)
Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan
Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of)
Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho
Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi
Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius
Mayotte Mexico Micronesia (Federated States of) Moldova (Republic of) Monaco
Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal
Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk
Island North Macedonia Norway Oman Pakistan Palau Palestinian Territory,
Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland
Portugal Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint
Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint
Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines
Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles
Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon
Islands Somalia South Africa South Georgia and the South Sandwich Islands South
Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden
Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of
Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey
Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates
United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela
(Bolivarian Republic of) Viet Nam Virgin Islands (British) Wallis and Futuna
Western Sahara Yemen Zambia Zimbabwe
ATM/Kiosk State: [None] Alabama Alaska American Samoa Arizona Arkansas
California Colorado Connecticut Delaware District of Columbia Florida Georgia
Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland
Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada
New Hampshire New Jersey New Mexico New York North Carolina North Dakota
Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode
Island South Carolina South Dakota Tennessee Texas United States Minor Outlying
Islands Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia
Wisconsin Wyoming
Originating Bank State: [None] Alabama Alaska American Samoa Arizona Arkansas
California Colorado Connecticut Delaware District of Columbia Florida Georgia
Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland
Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada
New Hampshire New Jersey New Mexico New York North Carolina North Dakota
Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode
Island South Carolina South Dakota Tennessee Texas United States Minor Outlying
Islands Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia
Wisconsin Wyoming
Originating Bank Zip Code/Route:
ATM/Kiosk Zip Code/Route:
Originating Name on Account:
Originating Account Number:
Originating Wallet Address:
Originating Account Identifier:
Prepaid/Gift Card Number:
--------------------------------------------------------------------------------
Recipient Bank Name:
Recipient Bank Address:
Recipient Bank Address (cont.):
Recipient Bank Suite/Mail Stop:
Recipient Bank City:
Recipient Bank Country: [None] United States of America Afghanistan Åland
Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda
Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh
Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational
State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana
Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria
Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central
African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands
Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa
Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti
Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea
Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France
French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia
Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey
Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See
Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of)
Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan
Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of)
Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho
Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi
Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius
Mayotte Mexico Micronesia (Federated States of) Moldova (Republic of) Monaco
Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal
Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk
Island North Macedonia Norway Oman Pakistan Palau Palestinian Territory,
Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland
Portugal Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint
Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint
Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines
Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles
Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon
Islands Somalia South Africa South Georgia and the South Sandwich Islands South
Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden
Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of
Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey
Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates
United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela
(Bolivarian Republic of) Viet Nam Virgin Islands (British) Wallis and Futuna
Western Sahara Yemen Zambia Zimbabwe
Recipient Bank State: [None] Alabama Alaska American Samoa Arizona Arkansas
California Colorado Connecticut Delaware District of Columbia Florida Georgia
Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland
Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada
New Hampshire New Jersey New Mexico New York North Carolina North Dakota
Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode
Island South Carolina South Dakota Tennessee Texas United States Minor Outlying
Islands Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia
Wisconsin Wyoming
Recipient Bank Zip Code/Route:
Recipient Name on Account:
Recipient Name:
Recipient Bank Routing Number:
Recipient Account Number:
Recipient Wallet Address:
Recipient Account Identifier:
Recipient Identifier (email/phone):
Recipient Bank SWIFT Code:
Add Transaction
Previous (step 2)
Next (step 4)
Information About The Subject(s)
Please complete one section for each subject that caused this incident. If you
do not have all of the requested information, please provide as much as
possible. If subject(s) are not known, proceed to the next section.
Subject #1
Remove Subject Name:
Business Name:
Address:
Address (continued):
Suite/Apt./Mail Stop:
City:
Country: [None/Unknown] United States of America Afghanistan Åland Islands
Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina
Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados
Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of)
Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island
Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso
Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African
Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia
Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa Rica Côte
d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica
Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia
Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French
Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany
Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea
Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras
Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq
Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya
Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kuwait
Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya
Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives
Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico
Micronesia (Federated States of) Moldova (Republic of) Monaco Mongolia
Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands
New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North
Macedonia Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama
Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar
Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena,
Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin
(French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa
San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra
Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands
Somalia South Africa South Georgia and the South Sandwich Islands South Sudan
Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden
Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of
Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey
Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates
United Kingdom United States of America Uruguay Uzbekistan Vanuatu Venezuela
(Bolivarian Republic of) Viet Nam Virgin Islands (British) Wallis and Futuna
Western Sahara Yemen Zambia Zimbabwe
State: [None/Unknown] Alabama Alaska American Samoa Arizona Arkansas California
Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii
Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland
Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada
New Hampshire New Jersey New Mexico New York North Carolina North Dakota
Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode
Island South Carolina South Dakota Tennessee Texas United States Minor Outlying
Islands Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia
Wisconsin Wyoming
Zip Code/Route:
Phone Number: Numbers only (1112223333)
Email Address: Example: jdoe@email.com
Website/Social Media Account:
IP Address: 123.45.67.89 or 2001:abc::1234
Add Subject
Previous (step 3)
Next (step 5)
Description of Incident
Law enforcement or regulatory agencies may desire copies of pertinent documents
or other evidence regarding your complaint. Originals should be retained for use
by law enforcement agencies. It is not necessary to provide your evidence here.
*Describe what happened in your own words. Provide any information you have yet
to include in this complaint that may assist law enforcement in understanding
what happened.
Please limit responses to 3,500 characters
3500 characters allowed
3500 characters allowed
Previous (step 4)
Next (step 6)
Other Information
Please provide any technical details regarding this incident. This can include
email headers, cryptocurrency transaction metadata, ransomware hashes, etc.
Please limit responses to 5,000 characters
5000 characters allowed
5000 characters allowed
Are there any other witnesses or persons affected by this incident?
Please limit responses to 1,000 characters
1000 characters allowed
1000 characters allowed
If you have reported this incident to other law enforcement or government
agencies, please provide the name, phone number, email, date reported, report
number, etc.
Please limit responses to 1,000 characters
1000 characters allowed
1000 characters allowed
Is this an update to a previously filed complaint?
YesNo
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Privacy & Signature
Read the following statement below, and confirm your agreement by typing your
full name below in the box provided:
The collection of information on this form is authorized by one or more of the
following statutes: 18 U.S.C. § 1028 (false documents and identity theft); 1028A
(aggravated identity theft); 18 U.S.C. § 1029 (credit card fraud); 18 U.S.C. §
1030 (computer fraud); 18 U.S.C. § 1343 (wire fraud); 18 U.S.C 2318B
(counterfeit and illicit labels); 18 U.S.C. § 2319 (violation of intellectual
property rights); 28 U.S.C. § 533 (FBI authorized to investigate violations of
federal law for which it has primary investigative jurisdiction); and 28 U.S.C.
§ 534 (FBI authorized to collect and maintain identification, criminal
information, crime, and other records).
The collection of this information is relevant and necessary to document and
investigate complaints of Internet-related crime. Submission of the information
requested is voluntary; however, your failure to supply requested information
may impede or preclude the investigation of your complaint by law enforcement
agencies.
The information collected is maintained in one or more of the following Privacy
Act Systems of Records: the FBI Central Records System, Justice/FBI-002, notice
of which was published in the Federal Register at 63 Fed. Reg. 8671 (Feb. 20,
1998); the FBI Data Warehouse System, DOJ/FBI-022, notice of which was published
in the Federal Register at 77 Fed. Reg. 40631 (July 10, 2012). Descriptions of
these systems may also be found at www.justice.gov/opcl/doj-systems-records#FBI.
The information collected may be disclosed in accordance with the routine uses
referenced in those notices or as otherwise permitted by law. For example, in
accordance with those routine uses, in certain circumstances, the FBI may
disclose information from your complaint to appropriate criminal, civil, or
regulatory law enforcement authorities (whether federal, state, local,
territorial, tribal, foreign, or international). Information also may be
disclosed as a routine use to an organization or individual in both the public
or private sector if deemed necessary to elicit information or cooperation from
the recipient for use by the FBI in the performance of an authorized activity.
"An example would be where the activities of an individual are disclosed to a
member of the public in order to elicit his/her assistance in [FBI's]
apprehension or detection efforts." 63 Fed. Reg. 8671, 8682 (February 20, 1998).
By typing my name below, I understand and agree that this form of electronic
signature has the same legal force and effect as a manual signature. I affirm
that the information I provided is true and accurate to the best of my
knowledge. I understand that providing false information could make me subject
to fine, imprisonment, or both. (Title 18, U.S.Code, Section 1001)
*Digital Signature:
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IC3
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CONTACT THE FBI PRESS OFFICE
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CONFIRM ACTION
* Yes, proceed
* No, cancel and return to form
TRANSACTION TYPE DEFINITIONS
Cash Money in the form of coins or bills. Check/Cashier's Check A document that
orders a bank, building society to pay a specific amount of money from a
person's account to the person in whose name the check has been issued.
Cryptocurrency/Crypto ATM Cryptocurrencies are digital tokens. Cryptocurrency
payments may be made through an exchange or directly to the recipient. A Crypto
ATM or kiosk that allows a person to purchase Bitcoin and other cryptocurrencies
by using cash or debit card. Debit Card/Credit Card Payment cards that can be
used in place of cash to make purchases. A debit card is usually linked to a
bank account. A credit card is linked to a line of credit. Money Order A printed
order for payment of a specified sum from prepaid funds, issued by a bank or
Post Office. Peer-to-Peer Transfer A Peer-to-Peer (or P2P) transaction is an
electronic payment method via a third-party application or website that allows
users to send money directly between two parties with separate bank accounts.
Prepaid/Gift Card A prepaid/gift card is not linked to a bank or credit union
account. Instead, money is deposited or "loaded" onto the card with a certain
amount before the card can be used. Wire Transfer Types of electronic fund
transfers to send money directly from one account to another. A wire transfer is
a transaction initiated through a bank moving funds from one account to another
at an external bank, can be domestic or international. This includes ACH
transactions, which involve the transfer of funds between banks, credit unions,
or other financial institutions through an electronic network.
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ROUTING NUMBER DEFINITION
A routing number (also known as an "RTN" or "ABA Routing Number") is a code used
by financial institutions to identify one another, usually for electronic fund
or wire transfers. It may have been provided as payment instructions by the
individuals or organizations you are reporting
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SWIFT CODE DEFINITION
A SWIFT Code is an eight- or eleven-character code made up of letters and
numbers that are used in international transfers of money. It may have been
provided as payment instructions by the individuals or organizations you are
reporting, particularly if the money is being sent to another country. For
example: AAAABBC1 or AAAABBC1234
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PEER-TO-PEER ACCOUNT IDENTIFIERS
Please use an email address or a phone number for an Account Identifier in a
Peer-to-Peer transaction if possible.
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TYPE OF CRYPTOCURRENCY
Type of cryptocurrency you sent as part of this transaction. (For example:
Bitcoin, Ethereum, Tether, Litecoin, etc.)
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TRANSACTION ID/HASH
Example: 0xfa485de419011ceefdd3cd00a4ff64e52bf9a0dfa528e4fff8bb4c9c. The ID/Hash
is typically much longer than a crypto address or P2P account identifier.
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CRYPTOCURRENCY ATM/KIOSK
If you used a cryptocurrency ATM/Kiosk, include the type/name, such as Bitcoin
Depot, CoinFlip, Margo, etc.
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ATM/KIOSK ADDRESS
Include the physical address of the ATM/Kiosk
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ORIGINATING WALLET ADDRESS
Your wallet address. Example: 0x58566904f57eac4E9EDd81BbC2f877865ECd35985. An
address is approximately 26-63 characters. If you do not have the whole address,
include what you do have.
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RECIPIENT WALLET ADDRESS
The wallet address where you sent funds. Example:
0x58566904f57eac4E9EDd81BbC2f877865ECd35985. An address is approximately 26-63
characters. If you do not have the whole address, include what you do have.
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TYPE OF PREPAID/GIFT CARD
The type of prepaid or gift card purchased as part of this transaction. (For
example: Visa, MasterCard, Macys, Home Depot, Steam, etc.)
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TERMS AND CONDITIONS
Prior to filing a complaint with the IC3, please read the following information
regarding terms and conditions.
Should you have additional questions prior to filing your complaint, view FAQ
for more information on inquiries such as:
* What details will I be asked to include in my complaint?
* What happens after I file a complaint?
* How are complaints resolved?
* Should I retain evidence related to my complaint?
Complaints filed via this website are analyzed and may be referred to federal,
state, local or international law enforcement and partner agencies for possible
investigation.
The complaint information you submit to this site is encrypted via secure socket
layer (SSL) encryption. Please see the Privacy Policy for further information.
We thank you for your cooperation.
--------------------------------------------------------------------------------
By clicking "I Accept" you acknowledge the following:
I understand any contact or investigation regarding any complaint I file on this
website is initiated at the discretion of the agency receiving the complaint
information. I will not be contacted by the IC3.
The information I'm providing on this form is correct to the best of my
knowledge. I understand that providing false information could make me subject
to fine, imprisonment, or both. (TITLE 18, U.S. CODE, SECTION 1001)
* Accept
* Decline