House Oversight Form with Generic Investigation Checklist

ev. 12-19-06) © Accomplishment Report @ Date Prepared oe of ‘Squad supervisor approval (Accomplishment must be reported and loaded into : Date Loaded / & (please initial) ISRAA within 30 days from date of accomplishment) Date Loader’s Initials | Investigative Assistance or Technique Used File Number {. Used, but did not help 3. Helped, substantially o E-MMN-[oKvocz 2. Helped, minimally 4, Absolutely essential ial For Sub. invest. Assist. by other FO(s) indicate A, B, C, D for corresponding FO Bankruptey Fraud | a Rate FO IAT Rate FO IA Rate FO 1A Rate FO IAT iT T [ARB Somer [|| Phto cover | xin it ss) | | [eensenon | rovoreon | Mics Neo Foal | | | feusunvrisc | | [seach Waren] Mcisswoo-tocal| | | [evsurstan |_| Show Money 7 ERT Asst. |_| cro ricsse| | [soca | | [en9.Tepe x | MM svetTeom | [Misav-rre |_| BD cus asst | IM Tech. creaui,| [Poor |_| | [Es Porcheso| li) Prone Tot Rec] MMFLMon.-1To |_| Finowinre [| [uco-Groupt | fron tang rcst |_| [tab Ok Eran] | —[vco-crevp | Non FBILop=x| |_| A. Complaint / Information/ Indictment F. Conviction J. Civil Rico Matters Date: (CiFederal ([JLocat [International []Federal []Local [7 Intemational Also complete “Section G” Complaint Date: Conviction Dates Other Civil Matters Date: Computer Fraud/Abuse O Corruption of Public Official Money Laundering Sub Invest Asst by FO(s) Asst, FO(s) A B. CG. Dz. Viet-Witn Coor 10 Wanted Flyer OFC/CID Check if Civil Rico Complaint [1] Subject Description Code *{—~j Judgment... Judicial Outcome - °x Amount $ Suspension: Years Months Information Date: For 6F, G, H-Include Agency Code (Felony or ( Misdemeanor [Plea or 0 Trial B, Locate / Arrest State:_________ Judicial District: _____. , K. Administrative Sanction Date:, [Federal [Local [] Internationat- ° Subject Description Code G. U.S, Code Violation Type: Length: Subject Priority A OB [1c Required for sections A, B, F and J se H Siepemien & | Paanaient Indictment Date: LocateDate: | (Federal Only) Debarment or Arrest Date: Title Section # Counts Injunction ——_Year. Months (1) Subject Resisted Arrest err nel _ L. Asset Seizure Date:. (1 Subject Arrested was Armed Asset Forfeiture Date: ———— ee TT CATS # Mandatory Cc. Summons Date: Circle below one of the three asset forfeiture: (O Federat [[] Local Admin, Civil Judicial, or Criminal Do not indicate $ value in Section D D. Recovery / Restitution / PELP X o Rat indicate Salven Section ‘ H. Sentence Date: Federal Local International a Fiat O O fone! Sentence Type: M. Acquittal/ Dismissal/ Pretrial Diversion ecovery Date: f ' ' Code * v Amount $ Code*__s vy =Amount $ Restitution Date: (Court Ordered = [[)] Pretrial Diversion Probation: = Years______ Months__ Drug Code * - Code * Y Amount $ ' Fines: $e te ode PELP Date: . Do not indicate $ in Section D Cede * ¥ Amount $——______. |. Disruption/Dismantlement: ~“ E, Hostages(s) Released Date:______ Disruption Date: O. Child Victim Information Released by: [1 Terrorist [1] Other Child located / identified Date: by 20 oX¥ Dismantlement Date: Number of Hostages: ___ Wu i D id Completion of FD-51a Side 2 Mandatory mang . [Beoease ey (Circle one) Date: In Jail: Years... Months, Suspended: Years___.___._ Months____ N. Drug Seizures “ Date: P. Subject Information - Required for all blocks excluding block D (Recovery/PELP), blocks E, f, Land N | | || Race* | Sex | Date of Birth Social Security No. (if available) Leth { related to an LCN, Asian Organized Cama (AOC), Italtan Organized Cnme ({0C), Russian/Eastern European, Caribbean, or Nigerian Organized Crime Group - Complete FD-518a, Side 1 Blocks A-E mandatory, F-H as appropriate, Subject relatad to an OC/Drug organization, a VCMO Program National Gang Slralegy targel group, or a VCMO Program National Priority Initiative targel group « Complete FO-515a, Side 1 Blocks A-C only, x Additional information may be added by attaching another form or a plain sheet of paper for additional entries. pedal Norolneete « See codes on reverse side. Y Requires that an explanation be attached and loaded into ISRAA for recovery over $1 m and PELP over $5 m, disruption, dismantlement, and drug seizures. YE- WU-106062-) 74 b6 b7Cc b7E b6 b7C HOUSE_OVERSIGHT_021578