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INVESTIGATIONS DIVISION Complaint Form Received By: How Received: Titie: SA Pay Plan: O..8. Component: FBI EOD Date: Ayien Bow: Mise: FLB.E.No.: Phana: 4} - ZIP: D/L Ne.: VOIR: : Otfenses: 669 SSNO: Talle: SSa& Pay Plan: P.G.3.: Component: FBI EOD Date: Alaen New: Misc: F.B.I.No.: bé Home: (___ B.O.P.NO. : PIC Phone: () - mel | D/L No. ; b2 work: tos CEfenses: 689 phone: Qo | Z1P: Title: SSA Pay a D.O.R.: Component: FBI EGD Date! Bilen No. ;: Misc: F.B.1.N0.: Home: B.O.P.No.: Phone: () - ZIP: D/L No.: Work: , . Phone : c2o2)P iY ZIP: Confidential: Revealed: Authority: none Cetails: Information provided by the PBI/INSD reporting a potential [OB matter involving improperly received information. I0OB s2000f Horing an authorizea investigation, the FRI properly served a Nations! Security Letter {NEL: cn a cemmunications provider for information regarding the target of tne FEE investigation. In respense, the FBI obtained information beyond the scope of the NSL. The FBI ievision adenrified the problem and irdicated that the unaulhors zed i zed wafoumabion has net been analyzed or added to any databases and has been sequestered witht dec. it is ihe Ooinicn of the Offace of the General Counsel thah this matter neea not be reported ro the 104. ALLEGATIONS: 689 108 Violation Occurrence Date: DIE 06/08/2006 TIME: DISPCSITION DATA: Oisposition: M Date: O1/08/2007 Approval: POWELL, GLENN G tLe Referred to Agency: date Sent: Comporent: FBi Patrsol Act: N Civil Rionts: N Component Number: 263 4 U 678, 2569 Sensitive: N Whistleblower: 4 Consolidated Case Number: ALL FBI INFORMATION CONTAINED HEREIN 15 UNCLASSIFIED DATE 06-06-2007 BY 65179/DNH/RSR/RU