PS Form 8165 - U.S. Postal Inspection Service Mail Fraud Report

Important! The form should be completed IN CAPITAL LETTERS using a BLACK or DARK BLUE ballpoint/fountain pen.

Characters and marks should be similar in the style to the following:

SUBJECT OF COMPLAINT

Company Name

First Name City

Last Name ZIP + 4

Country

Address

Cell Phone (Include Area Code) Work Phone (Include Area Code) Home Phone (Include Area Code)

− − − − − −

Fax Phone (Include Area Code) Email Address

− −

Website Address

YOUR INFORMATION

First Name Last Name

Address

City

ZIP + 4 Country

Email Address

Cell Phone (Include Area Code) Work Phone (Include Area Code) Home Phone (Include Area Code)

− − − − − −

HOW WERE YOU CONTACTED?

KEEP ANY ORIGINAL DOCUMENTS. WE MAY CONTACT YOU ABOUT THE DOCUMENTS.

Check one of the following:

 U.S. Mail

™

 Telephone  Internet ISP  Website  Email  Phone App  Other

Explain ______________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

On what date were you contacted?

If by mail, do you have the envelope it

was mailed in?

 Yes

 No

Does the envelope have a permit number?

Permit Number

/ /

Does the envelope have a postage meter number?  Yes

 No

Postage Meter Number Permit City

State

U.S. Postal Inspection Service Mail Fraud Report

Age Range

 12–17

 18–19

 20–29

 30–39

 40–54

 55–64

 65 or older

Veteran Status

 Yes

 No

Permit State

PS Form 8165, July 2021, (Page 1 of 4) See page 4 for Privacy Act Statement

HOW DID YOU RESPOND TO THIS OFFER?

Check one of the following:

 U.S. Mail

™

 Telephone  Internet ISP  Website  Email  Phone App  Other

Explain ______________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

To what name and address did you mail your response?

Do you have a tracking number?  Yes

 No

Tracking Number

What did you receive? _________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

How did it differ from what you expected? _______________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

How much did the company ask you to pay?

Do you have the item?  Yes

 No

How was it delivered?

 U.S. Mail

 Private Courier  In Person  Other _________________________________________________________________________

______________________________________________________________________________________________________________________________________________

Have you contacted the company or person about the complaint?  Yes

 No

If yes, date of last contact

/ /

If no, why?  Address Unavailable  Addressee Not at Address

 Disconnected Telephone  Unlisted Telephone  Unanswered Telephone

Legitimate businesses appreciate feedback. Check the offer for the delivery time, usually 6-8 weeks; then contact the company. Wait 2 weeks after

contacting them before sending us this form. When a delivery time is not specied, a Federal Trade Commission rule mandates fulllment within 30 days,

unless you applied for rst-time credit with the company.

DID YOU LOSE MONEY?

 No

 Yes

If yes, how much (in U.S. dollars)? Date of Last Payment

/ /

How did you pay? (Check one)

 Cash

 Postal Money Order (Provide Postal Money Order Number)

 Money Transfer Service (Provide Transfer Service Name and Number)

Transfer Number

 Pay Pal

 Debit Card/Credit Card  Check  Other Money Order  Virtual Currency

 Other (explain) ____________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

PS Form 8165, July 2021, (Page 2 of 4) See page 4 for Privacy Act Statement

PS Form 8165, July 2021, (Page 3 of 4) See page 4 for Privacy Act Statement

TYPE OF MAIL FRAUD COMPLAINT

Find the general category below that describes your area of concern, and check the specic item. (Check one only.)

Advance Payment



Credit Card



Credit Repair, Debt Consolidation



Loans



Medical Services



Chain Letter



Charity Fraud



Contest, Prize, or Sweepstakes

Education Fraud



Certication



Degree

Employment



Distributorship, Multilevel Marketing



Overseas Job



Postal Service Job



Secret Shopper



Work at Home

False Bill or Notice



Classied Ad



Collection Agency Notice



Directory Solicitation



Ofce Supplies



Subscription/Periodical



Taxes

Fiduciary (Perpetrated by person in position of trust, nancial

advisor, attorney, etc.)



Bribery, Kickbacks, Embezzlements



Estate



Financial Planning



Will



Harassment (Merchandise ordered in your name

without vour consent.)

Insurance



Health Care-Related



Life Insurance Related



Property Insurance Related



International Fraud



Impostor (e.g., IRS, Social Security, grandchild,

grandparent)

Investment



Franchise



Gems, Coins, Precious Metals



Securities, Stocks

Lottery (You pay to play)



Domestic



Foreign

Medical Quackery



Medical Cure



Sexual Aid



Weight Loss

Merchandise or Services



Failure to Pay



Failure to Provide



Internet Auction



Misrepresentation of Product or Service

Mortgage Fraud



Foreclosure Rescue



Mortgage Modication



Reverse Mortgage

Personal



Dating Service



False Divorce Decree



Mail Order Bride

Real Estate



Land Sales



Timeshare



Vacation or Travel



Sexually Oriented Advertisement

 Other ________________________________________

ADDITIONAL INFORMATION

Use the space below to provide any other, important information about this complaint:

______________________________________________________________________________________________________________________________________________

Thank you for completing this form. Mail the form and copies of bills, receipts, advertisements, canceled checks (front and back), or correspondence

related to your report to the address below. Do not mail your original. The U.S. Postal Inspection Service is a federal law enforcement agency, and Postal

Inspectors gather facts and evidence to determine whether a violation has occurred under the Mail Fraud or False Representation Statutes. While we

can’t guarantee you will recover money lost to fraud, your information can help alert Inspectors about new fraud schemes and prevent others from being

victimized. Postal Inspectors base mail fraud investigations on the number, substance, and pattern of complaints received from the public; therefore,

we ask you to keep all original documents relating to your complaint, including the solicitation, any mailing envelopes, and canceled checks. Under our

Consumer Protection Program, Postal Inspectors may contact individuals or businesses on your behalf to request that complaints be resolved. We will

contact you if more information is needed. Postal Inspectors caution that, once you have been targeted in a fraud scheme, your name may be passed

along to other con artists, so beware of future solicitations. If you know of others who believe they were victimized by fraud, we recommend they submit

a Mail Fraud Report. Postal Inspectors suggest that, before completing a business transaction, contact the Chamber of Commerce, Better Business

Bureau, or county or state Ofce of Consumer Affairs where the rm is located to get information on the company. Visit the Better Business Bureau at

bbb.org, the state National Association of Attorneys General at naag.org, and the Postal Inspection Service at www.uspis.gov for more information on

fraud involving use of the mail. Remember: If a deal sounds too good to be true, it probably is!

Return this form to your postmaster, or mail to:

CRIMINAL INVESTIGATIONS SERVICE CENTER

ATTN: MAIL FRAUD

433 W HARRISON STREET, RM 3255

CHICAGO IL 60699-3255

PRIVACY ACT STATEMENT

Your information will be used to submit a mail fraud report and to support investigations of criminal, civil, or administrative matters. Collection is authorized by 39

U.S.C. 401 and 404; and 18 U.S.C. 3061.

Supplying the information is voluntary, but if not provided, we may not be able to investigate your mail fraud complaint. We do not disclose your information to

third parties without your consent, except to act on your behalf or request, or as legally required. This includes the following limited circumstances: Incident to

legal proceedings that the U.S. Postal Service (USPS®) is a party to or has an interest in litigation; for law enforcement purposes when the USPS becomes aware

of an actual or potential violation of law; to a congressional ofce in response to an inquiry; to entities or individuals under contract or agreement with USPS to

fulll a function or provide a product or service; to government agencies and other entities authorized to perform audits; to labor organizations as required by law;

to a federal, state, local, or foreign government agency when necessary in connection with decisions by the requesting agency or USPS; to the Equal Employment

Opportunity Commission when requested in connection with the investigation of a formal complaint; to the Merit Systems Protection Board or Ofce of Special

Counsel for the purpose of litigation; to the public, news media, trade associations, or organized groups to provide information of interest to the public; to a

federal, state, local or foreign prison, probation, parole, or pardon authority or to any other agency involved with the maintenance, transportation, or release of a

person held in custody; and to a foreign country as authorized by an international treaty, convention, or executive agreement or to the extent necessary to assist

such country in apprehending or returning a fugitive to its jurisdiction. For more information on our privacy policies visit www.usps.com/privacypolicy.

Name and Signature Date

/ /

PS Form 8165, July 2021, (Page 4 of 4)