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Report IP Theft — IPRCenter

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class="plone-breadcrumb" role="navigation" aria-label="You are here:"> <ul class="breadcrumbs"> <li id="breadcrumbs-home"> <a href="https://www.iprcenter.gov">Home</a> </li> <li id="breadcrumbs-1"> <a href="https://www.iprcenter.gov/referral">Report Form</a> </li> <li id="breadcrumbs-2"> <span id="breadcrumbs-current">Report IP Theft</span> </li> </ul> </nav> </div> <article id="content"> <h1 class="documentFirstHeading">Report IP Theft</h1> <div id="content-core"> <div class="form"> <p class="discreet">This form is used to report violations of intellectual property rights, including counterfeiting Report IP Theft and piracy, to the National IPR Coordination Center.</p> <form data-pat-autotoc="levels: legend; section: fieldset; className: autotabs" class="rowlike enableUnloadProtection easyformForm kssattr-formname-view" action="https://www.iprcenter.gov/referral/report-ip-theft-form" method="post" enctype="multipart/form-data" id="form"> <div id="formPrologue"><p><img class="image-inline" src="https://www.iprcenter.gov/image-repository/graphic_report_theft.png/@@images/935a9025-8d05-4e38-b5b4-f81ecfb95126.png" alt="Report IP Theft" data-linktype="image" title="Report IP Theft" data-val="25002b481d544fe98b9e821e986c8267" data-scale="large"></p> <hr> <p><strong>The National Intellectual Property Rights Coordination Center (IPR Center)</strong> is the U.S. government's clearinghouse for investigations into counterfeiting and piracy &#8212; crimes that threaten the public's health and safety, the U.S. economy, and our war fighters.</p> <p>The IPR Center encourages members of the general public, industry, trade associations, law enforcement and government agencies to report potential violations of intellectual property rights through this website. Completion of this referral form is voluntary.</p> <p>In order to assist you in completing this form, we have developed a <a data-urltype="/view" data-val="a880eeeae23f4dbba74b2a4dbfa7ac36" data-linktype="internal" href="https://www.iprcenter.gov/file-repository/iprc-one-pager-scoring-matrix.pdf/view">lead-referral document</a> that explains the process in more detail.&#160;</p> <p>Additionally, the IPR Center accepts online complaints from actual victims as well as from third parties to the victims. While providing your contact information is voluntary, the IPR Center can best process a complaint if it receives accurate information in the form and has the ability to contact the complainant to clarify information that was provided, when necessary.</p></div> <!-- Default fieldset --> <div class="field z3cformInlineValidation kssattr-fieldname-form.widgets.information_about_the_individual_business_that_violated_intellectual_property_rights_" data-fieldname="form.widgets.information_about_the_individual_business_that_violated_intellectual_property_rights_" id="formfield-form-widgets-information_about_the_individual_business_that_violated_intellectual_property_rights_"> <label class="horizontal" for="form-widgets-information_about_the_individual_business_that_violated_intellectual_property_rights_"> <h3>Information about the Individual/Business that violated intellectual property rights:</h3> </label> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.business_name empty" data-fieldname="form.widgets.business_name" id="formfield-form-widgets-business_name"> <label for="form-widgets-business_name" class="horizontal"> Business Name <span class="formHelp">Business name for the business that violated intellectual property</span> </label> <div class="fieldErrorBox"></div> <input id="form-widgets-business_name" name="form.widgets.business_name" class="text-widget textline-field" value="" type="text"> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.full_name empty" data-fieldname="form.widgets.full_name" id="formfield-form-widgets-full_name"> <label for="form-widgets-full_name" class="horizontal"> Full Name <span class="formHelp">Full name of individual or business that violated intellectual property</span> </label> <div class="fieldErrorBox"></div> <input id="form-widgets-full_name" name="form.widgets.full_name" class="text-widget textline-field" value="" type="text"> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.location empty" data-fieldname="form.widgets.location" id="formfield-form-widgets-location"> <label for="form-widgets-location" class="horizontal"> Location <span class="formHelp">Any location information (address, state, country) of individual or business that violated intellectual property</span> </label> <div class="fieldErrorBox"></div> <textarea name="form.widgets.location" class=""></textarea> <select id="form-widgets-location_text_format" name="form.widgets.location.mimeType" class="pat-textareamimetypeselector" data-pat-textareamimetypeselector='{"widgets": {"text/html": {"patternOptions": {"relatedItems": {"vocabularyUrl": "https://www.iprcenter.gov/@@getVocabulary?name=plone.app.vocabularies.Catalog"}, "loadingBaseUrl": 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(128x128)", "part": "thumb", "name": "thumb"}, {"label": "Mini (200x200)", "part": "mini", "name": "mini"}, {"label": "Preview (400x400)", "part": "preview", "name": "preview"}, {"label": "Large (768x768)", "part": "large", "name": "large"}, {"label": "High (1400x1400)", "part": "high", "name": "high"}]}, "pattern": "plaintexteditor"}}, "textareaName": "form.widgets.location"}'><option value="text/html" selected>text/html</option><option value="text/x-web-textile">text/x-web-textile</option></select> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.phone_number empty" data-fieldname="form.widgets.phone_number" id="formfield-form-widgets-phone_number"> <label for="form-widgets-phone_number" class="horizontal"> Phone Number <span class="formHelp">Phone number of individual or business that violated intellectual property</span> </label> <div class="fieldErrorBox"></div> <input id="form-widgets-phone_number" name="form.widgets.phone_number" class="text-widget textline-field" value="" type="text"> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.email_address empty" data-fieldname="form.widgets.email_address" id="formfield-form-widgets-email_address"> <label for="form-widgets-email_address" class="horizontal"> Email Address <span class="formHelp">Email address of individual or business that violated intellectual property</span> </label> <div class="fieldErrorBox"></div> <input id="form-widgets-email_address" name="form.widgets.email_address" class="text-widget textline-field" value="" type="text"> </div> <div class="field z3cformInlineValidation kssattr-fieldname-form.widgets.other_identifiers_about_the_individual_business_that_violated_intellectual_property_rights_" data-fieldname="form.widgets.other_identifiers_about_the_individual_business_that_violated_intellectual_property_rights_" 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id="formfield-form-widgets-ip_address"> <label for="form-widgets-ip_address" class="horizontal"> IP Address </label> <div class="fieldErrorBox"></div> <input id="form-widgets-ip_address" name="form.widgets.ip_address" class="text-widget textline-field" value="" type="text"> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.social_media_site empty" data-fieldname="form.widgets.social_media_site" id="formfield-form-widgets-social_media_site"> <label for="form-widgets-social_media_site" class="horizontal"> Social Media Site </label> <div class="fieldErrorBox"></div> <input id="form-widgets-social_media_site" name="form.widgets.social_media_site" class="text-widget textline-field" value="" type="text"> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.social_media_user_account empty" data-fieldname="form.widgets.social_media_user_account" id="formfield-form-widgets-social_media_user_account"> <label for="form-widgets-social_media_user_account" class="horizontal"> Social Media User Account </label> <div class="fieldErrorBox"></div> <input id="form-widgets-social_media_user_account" name="form.widgets.social_media_user_account" class="text-widget textline-field" value="" type="text"> </div> <div class="field z3cformInlineValidation kssattr-fieldname-form.widgets.type_of_commodity_" data-fieldname="form.widgets.type_of_commodity_" id="formfield-form-widgets-type_of_commodity_"> <label class="horizontal" for="form-widgets-type_of_commodity_"> <h3 class="p1">Type of Commodity:</h3> </label> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.does_your_complaint_involve_a_government_contract_ empty" data-fieldname="form.widgets.does_your_complaint_involve_a_government_contract_" id="formfield-form-widgets-does_your_complaint_involve_a_government_contract_"> <label for="form-widgets-does_your_complaint_involve_a_government_contract_" class="horizontal"> Does your complaint involve a government contract? </label> <div class="fieldErrorBox"></div> <span class="option"> <label for="form-widgets-does_your_complaint_involve_a_government_contract_-0"> <input id="form-widgets-does_your_complaint_involve_a_government_contract_-0" name="form.widgets.does_your_complaint_involve_a_government_contract_" class="radio-widget bool-field" value="true" type="radio"> <span class="label">yes</span> </label> </span> <span class="option"> <label for="form-widgets-does_your_complaint_involve_a_government_contract_-1"> <input id="form-widgets-does_your_complaint_involve_a_government_contract_-1" name="form.widgets.does_your_complaint_involve_a_government_contract_" class="radio-widget bool-field" value="false" type="radio"> <span class="label">no</span> </label> </span> <input name="form.widgets.does_your_complaint_involve_a_government_contract_-empty-marker" type="hidden" value="1"> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.what_type_of_commodity_was_involved__ empty" data-fieldname="form.widgets.what_type_of_commodity_was_involved__" id="formfield-form-widgets-what_type_of_commodity_was_involved__"> <label for="form-widgets-what_type_of_commodity_was_involved__" class="horizontal"> What type of commodity was involved? <span class="formHelp">Select applicable commodities</span> </label> <div class="fieldErrorBox"></div> <select id="form-widgets-what_type_of_commodity_was_involved__" name="form.widgets.what_type_of_commodity_was_involved__:list" class="select-widget set-field" multiple size="5"> <option id="form-widgets-what_type_of_commodity_was_involved__-0" value="Automotive Parts/Accessories">Automotive Parts/Accessories</option><option id="form-widgets-what_type_of_commodity_was_involved__-1" value="CDs Piracy: Music">CDs Piracy: Music</option><option id="form-widgets-what_type_of_commodity_was_involved__-2" value="Cigarettes">Cigarettes</option><option id="form-widgets-what_type_of_commodity_was_involved__-3" value="Cyber Financial Fraud">Cyber Financial Fraud</option><option id="form-widgets-what_type_of_commodity_was_involved__-4" value="DVDs Piracy: Movie ">DVDs Piracy: Movie </option><option id="form-widgets-what_type_of_commodity_was_involved__-5" value="DVDs Piracy: TV">DVDs Piracy: TV</option><option id="form-widgets-what_type_of_commodity_was_involved__-6" value="Electronics: Computer Accessories">Electronics: Computer Accessories</option><option id="form-widgets-what_type_of_commodity_was_involved__-7" value="Electronics: Computer Hardware">Electronics: Computer Hardware</option><option id="form-widgets-what_type_of_commodity_was_involved__-8" value="Electronics: Computer Software">Electronics: Computer Software</option><option id="form-widgets-what_type_of_commodity_was_involved__-9" value="Food Substances">Food Substances</option><option id="form-widgets-what_type_of_commodity_was_involved__-10" value="Hygiene/Cosmetics ">Hygiene/Cosmetics </option><option id="form-widgets-what_type_of_commodity_was_involved__-11" value="Pharmaceuticals">Pharmaceuticals</option><option id="form-widgets-what_type_of_commodity_was_involved__-12" value="Trade Secrets Theft">Trade Secrets Theft</option><option id="form-widgets-what_type_of_commodity_was_involved__-13" value="Wearing Apparel/Accessories: Handbags">Wearing Apparel/Accessories: Handbags</option><option id="form-widgets-what_type_of_commodity_was_involved__-14" value="Wearing Apparel/Accessories: Jerseys">Wearing Apparel/Accessories: Jerseys</option><option id="form-widgets-what_type_of_commodity_was_involved__-15" value="Wearing Apparel/Accessories: Jewelry">Wearing Apparel/Accessories: Jewelry</option><option 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"name": "high"}]}, "pattern": "plaintexteditor"}}, "textareaName": "form.widgets.description_of_the_incident"}'><option value="text/html" selected>text/html</option><option value="text/x-web-textile">text/x-web-textile</option></select> </div> <div class="field z3cformInlineValidation kssattr-fieldname-form.widgets.organizations_label" data-fieldname="form.widgets.organizations_label" id="formfield-form-widgets-organizations_label"> <label class="horizontal" for="form-widgets-organizations_label"> <h3>Organizations</h3> </label> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_ empty" data-fieldname="form.widgets.have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_" id="formfield-form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_"> <label for="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_" class="horizontal"> Have you already reported this crime to any law enforcement or government agencies? If yes, please indicate the organizations/ individuals that you contacted (select all that apply) </label> <div class="fieldErrorBox"></div> <select id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_" name="form.widgets.have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_:list" class="select-widget set-field" multiple size="5"> <option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-0" value="Automotive Parts/Accessories">Automotive Parts/Accessories</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-1" value="CDs Piracy: Music">CDs Piracy: Music</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-2" value="Cigarettes">Cigarettes</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-3" value="Cyber Financial Fraud">Cyber Financial Fraud</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-4" value="Digital Piracy">Digital Piracy</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-5" value="DVDs Piracy: Movie ">DVDs Piracy: Movie </option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-6" value="DVDs Piracy: TV">DVDs Piracy: TV</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-7" value="Electronics: Computer Accessories">Electronics: Computer Accessories</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-8" value="Electronics: Computer Hardware">Electronics: Computer Hardware</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-9" value="Electronics: Computer Software">Electronics: Computer Software</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-10" value="Food Substances">Food Substances</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-11" value="Hygiene/Cosmetics">Hygiene/Cosmetics</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-12" value="Pharmaceuticals">Pharmaceuticals</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-13" value="Trade Secrets Theft">Trade Secrets Theft</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-14" value="Wearing Apparel/Accessories: Handbags">Wearing Apparel/Accessories: Handbags</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-15" value="Wearing Apparel/Accessories: Jerseys">Wearing Apparel/Accessories: Jerseys</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-16" value="Wearing Apparel/Accessories: Jewelry">Wearing Apparel/Accessories: Jewelry</option><option id="form-widgets-have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-17" value="Wearing Apparel/Accessories: Shoes">Wearing Apparel/Accessories: Shoes</option> </select> <input name="form.widgets.have_you_already_reported_this_crime_to_any_law_enforcement_or_government_agencies__if_yes__please_indicate_the_organizations__individuals_that_you_contacted__select_all_that_apply_-empty-marker" type="hidden" value="1"> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.already_reported_crime_other empty" data-fieldname="form.widgets.already_reported_crime_other" id="formfield-form-widgets-already_reported_crime_other"> <label for="form-widgets-already_reported_crime_other" class="horizontal"> Other (Specify Other) </label> <div class="fieldErrorBox"></div> <input id="form-widgets-already_reported_crime_other" name="form.widgets.already_reported_crime_other" class="text-widget textline-field" value="" type="text"> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.do_you_have_pertinent_documents_correspondence_in_paper_or_electronic_form_ empty" data-fieldname="form.widgets.do_you_have_pertinent_documents_correspondence_in_paper_or_electronic_form_" id="formfield-form-widgets-do_you_have_pertinent_documents_correspondence_in_paper_or_electronic_form_"> <label for="form-widgets-do_you_have_pertinent_documents_correspondence_in_paper_or_electronic_form_" class="horizontal"> Do you have pertinent documents/correspondence in paper or electronic form? <span class="formHelp">*Original documents should be retained for use by law enforcement agencies*</span> </label> <div class="fieldErrorBox"></div> <span class="option"> <label for="form-widgets-do_you_have_pertinent_documents_correspondence_in_paper_or_electronic_form_-0"> <input id="form-widgets-do_you_have_pertinent_documents_correspondence_in_paper_or_electronic_form_-0" name="form.widgets.do_you_have_pertinent_documents_correspondence_in_paper_or_electronic_form_" class="radio-widget bool-field" value="true" type="radio"> <span class="label">yes</span> </label> </span> <span class="option"> <label for="form-widgets-do_you_have_pertinent_documents_correspondence_in_paper_or_electronic_form_-1"> <input id="form-widgets-do_you_have_pertinent_documents_correspondence_in_paper_or_electronic_form_-1" name="form.widgets.do_you_have_pertinent_documents_correspondence_in_paper_or_electronic_form_" class="radio-widget bool-field" value="false" type="radio"> <span class="label">no</span> </label> </span> <input name="form.widgets.do_you_have_pertinent_documents_correspondence_in_paper_or_electronic_form_-empty-marker" type="hidden" value="1"> </div> <div class="field z3cformInlineValidation kssattr-fieldname-form.widgets.contact_information" data-fieldname="form.widgets.contact_information" id="formfield-form-widgets-contact_information"> <label class="horizontal" for="form-widgets-contact_information"> <h3>Contact Information:</h3> <p>Your report will remain anonymous unless you choose to identify yourself; however, please note that failure to do so may limit or otherwise compromise the IPR Center and its partners&#8217; efforts to conduct an investigation based on your information. If you agree to be contacted with follow-up questions, if necessary, please enter your contact information:</p> </label> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.full_name_contact_information empty" data-fieldname="form.widgets.full_name_contact_information" id="formfield-form-widgets-full_name_contact_information"> <label for="form-widgets-full_name_contact_information" class="horizontal"> Full Name <span class="formHelp">Full name of individual to contact</span> </label> <div class="fieldErrorBox"></div> <input id="form-widgets-full_name_contact_information" name="form.widgets.full_name_contact_information" class="text-widget textline-field" value="" type="text"> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.business_name_contact_information empty" data-fieldname="form.widgets.business_name_contact_information" id="formfield-form-widgets-business_name_contact_information"> <label for="form-widgets-business_name_contact_information" class="horizontal"> Business Name <span class="formHelp">Business name of individual to contact</span> </label> <div class="fieldErrorBox"></div> <input id="form-widgets-business_name_contact_information" name="form.widgets.business_name_contact_information" class="text-widget textline-field" value="" type="text"> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.phone_number_contact_information empty" data-fieldname="form.widgets.phone_number_contact_information" id="formfield-form-widgets-phone_number_contact_information"> <label for="form-widgets-phone_number_contact_information" class="horizontal"> Phone Number <span class="formHelp">Phone number of individual to contact</span> </label> <div class="fieldErrorBox"></div> <input id="form-widgets-phone_number_contact_information" name="form.widgets.phone_number_contact_information" class="text-widget textline-field" value="" type="text"> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.email_address_contact_information empty" data-fieldname="form.widgets.email_address_contact_information" id="formfield-form-widgets-email_address_contact_information"> <label for="form-widgets-email_address_contact_information" class="horizontal"> Email Address <span class="formHelp">Email address of individual to contact</span> </label> <div class="fieldErrorBox"></div> <input id="form-widgets-email_address_contact_information" name="form.widgets.email_address_contact_information" class="text-widget textline-field" value="" type="text"> </div> <div class="field z3cformInlineValidation kssattr-fieldname-form.widgets.warning_regarding_knowingly_providing_false_information" data-fieldname="form.widgets.warning_regarding_knowingly_providing_false_information" id="formfield-form-widgets-warning_regarding_knowingly_providing_false_information"> <label class="horizontal" for="form-widgets-warning_regarding_knowingly_providing_false_information"> <h3 class="p1"><strong>WARNING REGARDING KNOWINGLY PROVIDING FALSE INFORMATION</strong></h3> <p>&#160;</p> <p>The information I've provided on this form is correct to the best of my knowledge. I understand that knowingly and willfully providing false information could subject me to fine, imprisonment, or both. (Title 18, U.S.C. &#167; 1001).</p> </label> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.the_information_ive_provided_on_this_form_is_correct_to_the_best_of_my_knowledge" data-fieldname="form.widgets.the_information_ive_provided_on_this_form_is_correct_to_the_best_of_my_knowledge" id="formfield-form-widgets-the_information_ive_provided_on_this_form_is_correct_to_the_best_of_my_knowledge"> <span class="option" id="form-widgets-the_information_ive_provided_on_this_form_is_correct_to_the_best_of_my_knowledge"> <input id="form-widgets-the_information_ive_provided_on_this_form_is_correct_to_the_best_of_my_knowledge-0" name="form.widgets.the_information_ive_provided_on_this_form_is_correct_to_the_best_of_my_knowledge:list" class="single-checkbox-widget required bool-field" value="selected" type="checkbox"> <label for="form-widgets-the_information_ive_provided_on_this_form_is_correct_to_the_best_of_my_knowledge-0"> <span class="label">I understand</span> </label> </span> <input name="form.widgets.the_information_ive_provided_on_this_form_is_correct_to_the_best_of_my_knowledge-empty-marker" type="hidden" value="1"> <div class="fieldErrorBox"></div> </div> <div class="field z3cformInlineValidation kssattr-fieldname-form.widgets.privacy_act_statement" data-fieldname="form.widgets.privacy_act_statement" id="formfield-form-widgets-privacy_act_statement"> <label class="horizontal" for="form-widgets-privacy_act_statement"> <p>&#160;</p> <div style="border: 1px solid black; padding: 10px; margin-bottom: 25px;"> <p class="p1"><strong>Privacy Act Statement - IPR Center Reporting Allegations of Counterfeiting and Intellectual Piracy Form</strong></p> <p class="p2"><strong>Authority:</strong> 5 U.S.C. &#167; 301; 5 U.S.C. &#167; 552a; 6 U.S.C. &#167; 203; 8 U.S.C. &#167; 1103; 19 U.S.C. &#167; 1589a; 44 U.S.C. &#167; 3101 authorize U.S. Immigration and Customs Enforcement (ICE) to collect your information requested in this web form.</p> <p class="p2"><strong>Purpose(s):</strong> The information being requested is collected and controlled by the ICE-led National Intellectual Property Rights Coordination Center (IPR Center) for the purpose of evaluating and further developing information in support of law enforcement investigations. The IPR Center may also use your information to contact you for additional and/or clarifying information about your report.</p> <p class="p2"><strong>Routine Use(s):</strong> Your information and the information you provide regarding suspicious or suspected criminal activity and/or violation of law may be shared internally within the Department of Homeland Security (DHS) for any appropriate law enforcement action. The information you provide may also be shared with other federal, state, local, tribal, territorial, or foreign agencies in order to refer reports of suspicious activity, tips, potential violations of law and other relevant information to those agencies with appropriate jurisdiction, authorities, and/or need-to-know concerning the matter(s) you report. The information you provide may also be disclosed as generally permitted under 5 U.S.C. &#167; 552a(b) of the Privacy Act of 1974, as amended, and pursuant to the routine uses published in the DHS system of records notice, DHS/ICE-009 External Investigations.</p> <p class="p3"><strong>Disclosure:</strong> Use of this form and the disclosure of your contact information when submitting this form are voluntary. Should you wish to submit an anonymous report verbally, you may call the IPR Center Hotline at 1-866-IPR-2060 or 1-866-477-2060.</p> <p class="p3"><strong>Public Reporting Burden</strong></p> <p class="p4">U.S. Immigration and Customs Enforcement is collecting this information as a part of its agency mission under the Department of Homeland Security. The estimated average time to review the instructions, search existing data sources, gather and maintain the data needed and completing and reviewing this collection of information is 30 minutes (.5 hours) per response. An agency may not conduct or sponsor, and a person is not required to respond to, an information collection unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to U.S. Immigration and customs Enforcement, Forms Management Office, 801 I Street NW, Washington D.C. 20536-5800. Do not mail your completed form to this address.</p> </div> </label> </div> <div data-pat-inlinevalidation='{"type":"z3c.form"}' class="field pat-inlinevalidation kssattr-fieldname-form.widgets.captcha empty" data-fieldname="form.widgets.captcha" id="formfield-form-widgets-captcha"> <label for="form-widgets-captcha" class="horizontal"> Captcha </label> <div class="fieldErrorBox"></div> <script src="https://www.google.com/recaptcha/api.js?hl=en-us&amp;fallback=False&amp;" async="async" defer></script> <div class="g-recaptcha" data-sitekey="6Ldl66EaAAAAAIWm3QMFnlHzSP-3l2_UgH1UCeU3" data-theme="light" data-type="image" data-size="normal"> </div> <noscript> <div style="width: 302px; height: 480px;"> <div style="width: 302px; height: 422px; position: relative;"> <div style="width: 302px; height: 422px; position: relative;"> <iframe src="https://www.google.com/recaptcha/api/fallback?k=6Ldl66EaAAAAAIWm3QMFnlHzSP-3l2_UgH1UCeU3&amp;hl=en-us" frameborder="0" scrolling="no" style="width: 302px; height:422px; 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