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Privacy Act Statement
Collection of this information
is authorized by 12 U.S.C. §§ 1818 and 1819 and 15 U.S.C. § 57a(f). The information
you provide to the FDIC on this form will be used to investigate and respond
to your complaint or inquiry. The information you provide may be disclosed to
the institution which is the subject of the complaint or inquiry and to any third
party sources, when necessary to investigate or resolve the complaint or inquiry;
to the Federal or State supervisory authority that has direct supervision over
the financial institution that is the subject of the complaint or inquiry; to
appropriate Federal, state or local authorities agencies if a violation or possible
violation of a civil or criminal law is apparent; to a congressional office in
response to an inquiry made at your request; to a court, magistrate or administrative
tribunal in the event of litigation, or in accordance with the other "routine
uses of records" listed in the FDIC's Consumer Complaint and Inquiry System of
Records, # 30-64-0005. Completing this form is voluntary, but failure to provide
all of the information may delay or preclude investigation of your complaint
or inquiry.
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