Form 102 Suspicious Activity Report by Casinos and Card Clubs

Suspicious Activity Report
by Casinos and Card Clubs

FinCEN
Form 102

April 2003
Please type or print. Always complete entire report. Items
Previous editions will not be
accepted after December 31, 2003 marked with an asterisk * are considered critical (see instructions).

OMB No. 1506 - 0006

1 Check the box if this report corrects a prior report (see instructions on page 6)

Part I

Subject Information

2 Check box (a)

box (b)

if more than one subject

*3 Individual’s last name or entity’s full name

subject information unavailable
5 Middle initial

*4 First name

6 also known as (AKA- individual), doing business as (DBA- entity)

7 Occupation / type of business

*8 Address

*9 City

*10 State

*12 Country (if not U.S.)

*11 ZIP code

*14 SSN / ITIN (individual) or EIN (entity)

*15 Account number

13 Vehicle license # / state (optional)
a. number
b. state

No account affected

No
*17 Government issued identification (if available)
d

a

Driver’s license/state ID

16 Date of birth

Account open ? Yes

b

Passport

d

____/____/_______
MM DD YYYY
Alien registration

Other ___________________________________________

e Number:

f Issuing state or country________________________

18 Phone number - work

19 Phone number - home

)

(

20 E-mail address (if available)

)

(

21 Affiliation or relationship to casino/card club
a

Customer

b

f

Supplier

g

Agent

c

Concessionaire

Junket / tour operator

h

d

Employee

e

Check cashing operator

Other (Explain in Part VI)

22 Does casino/card club still have a business association and/or an employee/employer relationship with suspect?
a

Yes b

Part II

No If no , why? c

Barred

d

Resigned

e

Terminated

Suspicious Activity Information
*25 Total dollar amount involved in suspicious activity

From _____/_____/_________
MM
DD
YYYY
Type of suspicious activity:
Bribery/gratuity
Check fraud (includes counterfeit)
Credit/debit card fraud (incl. counterfeit)
Embezzlement/theft
Large currency exchange(s)
Minimal gaming with large transactions

Part III

Other (Specify in Part VI) _____/_____/_________
MM
DD
YYYY

f

*24 Date or date range of suspicious activity

* 26
a
b
c
d
e
f

23 Date action taken(22)

To _____/_____/_________
MM
DD
YYYY
g
h
i
j
k
l

$

,

,

Misuse of position
Money laundering
No apparent business or lawful purpose
Structuring
Unusual use of negotiable instruments (checks)
Use of multiple credit or deposit accounts

m
n
o
p
q

,

.00

Unusual use of wire transfers
Unusual use of counter checks
or markers
False or conflicting ID(s)
Terrorist financing
Other (Describe in Part VI)

Law Enforcement or Regulatory Contact Information

27 If law enforcement or a regulatory agency has been contacted (excluding submission of a SARC), check the appropriate box.
a
b
c
d

DEA
U.S. Attorney (** 28)
IRS
FBI

e
f
g
h

U.S. Customs Service
U.S. Secret Service
Local law enforcement
State gaming commission

28 Other authority contacted (for box 27 g through l) ** List U.S. Attorney office here.
30 Telephone number of individual
contacted in box 29

(

i
j
k
l

State law enforcement
Tribal gaming commission
Tribal law enforcement
Other (List in item 28)

29 Name of person contacted (for all of box 27)
31 Date Contacted

)

_____/_____/_________
MM
DD
YYYY
Cataloge Number 35636U

Part IV

Reporting Casino or Card Club Information

2

*33 Legal name of casino or card club

*32 Trade name of casino or card club

*34 EIN

*35 Address
*36 City

*37 State *38 ZIP code

39 Type of gaming institution
a

State licensed casino

b

Tribal licensed casino

Card club

d

Other (specify)______________________

Contact for Assistance

Part V

*40 Last name of individual to be contacted regarding this report
*43 Title/Position

*41 First name

*44 Work phone number

(
Part VI

c

)

42 Middle initial
*45 Date report prepared
_____/_____/_________
MM
DD
YYYY

Suspicious Activity Information - Narrative*

Explanation/description of suspicious activity(ies). This section of the report is critical. The care with which it is completed may determine
whether or not the described activity and its possible criminal nature are clearly understood by investigators. Provide a clear, complete and chronological
description (not exceeding this page and the next page) of the activity, including what is unusual, irregular, or suspicious about the transaction(s), using
the checklist below as a guide as you prepare your account.
m. Indicate whether funds or assets were recovered and, if so, enter
a. Describe the conduct that raised suspicion.
the dollar value of the recovery in whole dollars only.
b. Explain whether the transaction(s) was completed or only attempted.
n. Indicate any additional account number(s), and any domestic or
c. Describe supporting documentation and retain such documentation for
foreign bank(s) account numbers which may be involved.
your file for five years.
o. Indicate for a foreign national any available information on subject’s
d. Explain who benefited, financially or otherwise, from the
passport(s), visa(s), and/or identification card(s). Include date, country,
transaction(s), how much and how (if known).
city of issue, issuing authority, and nationality.
e. Describe and retain any admission or explanation of the
p. Describe any suspicious activities that involve transfer of funds to or
transaction(s)provided by the subject(s), witness(s), or other person(s).
from a foreign country, or any exchanges of a foreign currency.
Indicate to whom and when it was given. Include witness or other
Identify the currency, country, sources and destinations of funds.
person ID.
q. Describe subject(s) position if employed by the casino or card club
f. Describe and retain any evidence of cover-up or evidence of an
(e.g., dealer, pit supervisor, cage cashier, host, etc.).
attempt to deceive federal or state examiners, or others.
r. Indicate the type of casino or card club filing this report, if this is not
g. Indicate where the possible violation of law(s) took place (e.g.,
clear from Part IV.
branch, cage, specific gaming pit, specific gaming area).
s. Describe the subject only if you do not have the identifying informah. Indicate whether the suspicious activity is an isolated incident or
tion in Part I or if multiple individuals use the same identification. Use
relates to another transaction.
descriptors such as male, female, age, etc.
i. Indicate whether there is any related litigation. If so, specify the
t . Indicate any wire transfer in or out identifier numbers, including the
name of the litigation and the court where the action is pending.
transfer company’s name.
j. Recommend any further investigation that might assist law
enforcement authorities.
u. If correcting a prior report, complete the form in its entirety and
k. Indicate whether any information has been excluded from this
note the changes here in Part VI.
report; if so, state reasons.
l. Indicate whether any U.S. or foreign currency and/or U.S. or foreign
negotiable instrument(s) were involved. If foreign, provide the
NOTE: Information already provided in earlier parts of this form
amount, name of currency, and country of origin.
need not necessarily be repeated if the meaning is clear.
Tips on SAR Form preparation and filing are available in the SAR Activity Review at www.fincen.gov/pub_reports.html.

Supporting documentation should not be filed with this report.

Maintain the information for your files.

Do not include legal disclaimers in this narrative. Continue on next page as necessary.

Suspicious Activity Report Narrative (continued from page 2)

.

3

FinCEN Form 102a
Safe Harbor Federal law (31 U.S.C. 5318(g)(3))
provides complete protection from civil liability
for all reports of suspicious transactions made to
appropriate authorities, including supporting documentation, regardless of whether such reports are
filed pursuant to this report’s instructions or are
filed on a voluntary basis. Specifically, the law
provides that a financial institution, and its directors, officers, employees and agents, that make a
disclosure of any possible violation of law or regulation, including in connection with the preparation of suspicious activity reports, “shall not be
liable to any person under any law or regulation of
the United States, any constitution, law, or regulation of any State or political subdivision of any
state, or under any contract or other legally enforceable agreement (including any arbitration agreement), for such disclosure or for any failure to
provide notice of such disclosure to the person
who is the subject of such disclosure or any other
person identified in the disclosure”.
Notification Prohibited Federal law (31 U.S.C.
5318(g)(2)) provides that a financial institution,
and its directors, officers, employees, and agents
who, voluntarily by means of a suspicious activity
report, report suspicious transactions to the government, may not notify any person involved in
the transaction that the transaction has been reported.
In situations involving suspicious transactions requiring immediate attention, such
as when a reportable transaction is ongoing, the financial institution shall immediately notify, by telephone, appropriate
law enforcement and financial institution
regulatory authorities in addition to filing
a timely suspicious activity report.
When To File A Report:
1. Every casino and card club (for purposes of
31 CFR 103, a “reporting casino”), shall file with
FinCEN, to the extent and in the manner required
by 31 CFR 103, a report of any suspicious
transaction relevant to a possible violation of
law or regulation. A casino may also file with
FinCEN, by using the Suspicious Activity Report
by Casinos (SARC), a report of any suspicious
transaction that it believes is relevant to the
possible violation of any law or regulation but
whose reporting is not required by 31 CFR 103.
2. A transaction requires reporting under the
terms of 31 CFR 103.21 if it is conducted or
attempted by, at, or through a casino, and involves
or aggregates at least $5,000 in funds or other
assets, and the casino knows, suspects, or has
reason to suspect that the transaction (or a pattern
of transactions of which the transaction is a part):
(i)Involves funds derived from illegal
activity or is intended or conducted in order to
hide or disguise funds or assets derived from illegal
activity (including, without limitation, the
ownership, nature, source, location, or control of

SAR- Casinos and Card Clubs Instructions
such funds or assets) as part of a plan to violate or
evade any federal law or regulation or to avoid
any transaction reporting require-ment under
federal law or regulation;
(ii) Is designed, whether through structuring
or other means, to evade any requirements of 31
CFR 103 or of any other regulations promulgated
under the Bank Secrecy Act, Public Law 91-508,
as amended, codified at 12 U.S.C. 1829b, 12 U.S.C.
1951-1959, and 31 U.S.C. 5311-5332;
(iii) Has no business or apparent lawful
purpose or is not the sort in which the particular
customer would normally be expected to engage,
and the casino knows of no reasonable explanation
for the transaction after examining the available
facts, including the background and possible
purpose of the transaction; or
(iv) Involves use of the casino to facilitate
criminal activity.
3. A SARC shall be filed no later than 30 calendar
days after the date of the initial detection by the
reporting casino of facts that may constitute a
basis for filing a SAR under this section. If no
suspect is identified on the date of such initial
detection, a casino may delay filing a SARC for an
additional 30 calendar days to identify a suspect,
but in no case shall reporting be delayed more
than 60 calendar days after the date of such initial
detection. In situations involving violations
that require immediate attention, such as ongoing
money laundering schemes, the reporting casino
shall immediately notify by telephone an
appropriate law enforcement authority in addition
to filing timely a SARC. Casinos wishing to
voluntarily report suspicious transactions that may
relate to terrorist activity may call FinCEN’s
Financial Institutions Hotline at 1-866-556-3974
in addition to filing timely a SARC if required by
31 CFR 103.
4. Exceptions. A casino is not required to file a
SARC for a robbery or burglary committed or
attempted that is reported to appropriate law
enforcement authorities.
5. The Bank Secrecy Act requires financial
institutions to file currency transaction reports
(CTRs) in accordance with the Department of the
Treasury’s implementing regulations (31 CFR Part
103). These regulations require a financial
institution to file a CTR whenever a currency
transaction exceeds $10,000. CFR 31 103.22(b)(2)
requires that all casinos and card clubs file using
FinCEN 103 (CTRC). If a currency transaction
exceeds $10,000 and is suspicious, the institution
must file both a CTRC reporting the currency
transaction and a suspicious activity report
reporting the suspicious aspects of the transaction.
If a currency transaction is $10,000 or less and is
suspicious, the institution should only file a
suspicious activity report. Appropriate records
must be maintained in each case. See: 31 CFR Part
103.

1

General Instructions
A. Abbreviations and Definitions:
1. AKA--also known as
2. DBA--doing business as
3. DEA--Drug Enforcement Administration
4. EIN--Employer Identification Number
5. FBI--Federal Bureau of Investigation
6. IRS--Internal Revenue Service (AML or CI)
7. ITIN--Individual Taxpayer Identification
Number
8. SSN--Social security number
B.

How to Make a Report:

1. This form should be e-filed through the
Bank Secrecy Act E-Filing System. Go to
http://bsaefiling.fincen.treas.gov to register.
This form is also available for download on the
Financial Crimes Enforcement Network’s Web site
at www.fincen.gov, or may be ordered by calling the
IRS Forms Distribution Center at (800) 829-3676.
If not filed electronically, send each completed
suspicious activity report to:
Detroit Computing Center
ATTN: SARC
P.O. Box 32621
Detroit, MI 48232-5980
2. While all items should be completed fully and
accurately, items marked with an asterisk (*) are
considered critical and must be completed according
to the provisions of paragraph 3 below and any
special item instructions.
3. If the information for a critical item marked
with an asterisk (*) is not known or not applicable,
enter special response “XX” as appropriate to complete the item. Non-asterisk fields should be left
blank if the information is unknown or not applicable. NOTE: The XX response for unknown may
not be used in item 24 (suspicious activity “From”
date), the check boxes in item 26 (one or more
boxes must be checked), and in Parts IV, V or VI.
4.Complete each suspicious activity report by
providing as much information as possible on
initial and corrected reports.
5. Do not include supporting documentation
with the suspicious activity report filed. Identify
and retain a copy of the suspicious activity report
and all supporting documentation or business
record equivalents for your files for five (5) years
from the date of the suspicious activity report.
All supporting documentation such as, canceled
checks, confessions, credit bureau reports, credit
slips/vouchers, deposit/withdrawal slips, multiple
transaction logs, player rating records, slot club
records, identification credentials, spreadsheets,
photographs, surveillance audio and/or video
recording media, and surveillance logs. For casinos
that have hotels, and in the absence of any
information other than a customer’s name, other
supporting documentation such as credit/debit

2
cards, guest folios, and safety deposit box
registrations. All supporting documentation
referenced above must be made available to
appropriate authorities upon request.
6. If more than one subject is being reported,
make a copy of page 1 and complete only the
subject information Part I, and attach the
additional page(s) behind page 1. If more space is
needed to complete any other item(s), identify
that item in Part VI by “item number”, and provide
the additional information.
7. Type or complete the report using block
written letters.
8. Enter all dates in MM/DD/YYYY format
where MM = month, DD = day, and YYYY = year.
Precede any single number with a zero, i.e., 01,
02, etc.
9. Enter all telephone numbers with (area
code) first and then the seven numbers, using the
format, (XXX) XXX-XXXX. List international
telephone and fax numbers in Part VI.
10. Always enter an individual’s name by
entering the last name, first name, and middle
initial (if known). If a legal entity is listed, enter
its name in the last name field.
11. Enter all identifying numbers (Alien
registration, Driver’s License/State ID, EIN, ITIN,
Foreign National ID, Passport, SSN, etc.) starting
from left to right. Do not include spaces, dashes
or other punctuation.
12. Enter all Post Office ZIP codes with at
least the first five numbers (all nine (ZIP+4)) if
known) and listed from left to right.
13. Enter all monetary amounts in U.S.
Dollars. Use whole dollar amounts rounded up when
necessary. Use this format: $0,000,000.00. If
foreign currency is involved, state name of the
currency and country of origin.
14. Addresses, general. Enter the permanent
street address, city, two letter state/territory
abbreviation used by the U.S. Postal Service and
ZIP code (ZIP+4 if known) of the individual or
entity. A post office box number should not be
used for an individual, unless no other address is
available. For an individual also enter any
apartment number or suite number, and road or
route number. If a P.O. Box is used for an entity,
enter the street name, suite number, and road or
route number. If the address of the individual or
entity is in a foreign country, enter the city,
province or state, postal code and the name of the
country. Complete any part of the address that is
known, even if the entire address is not known. If
from the United States, leave country box blank.

C.
Specific Suspicious Activity Report
Preparation Instructions:
Item 1-- *Check box, “corrects prior report”,
if this report is filed to correct a previously filed
SARC. To correct a report, a new SARC must be
completed in its entirety. Also note corrected
information in Part VI, (see line “u”).
Part I Subject Information
Note: Enter information about the person(s)
or entity involved that caused this report to
be filed, not the victim of the activity.

Casinos and card clubs may rely upon their own
internal records, including copies of federal forms,
which contain verified customer information, to
identify the subjects of these reports. These records
may include credit, deposit, or check cashing
account records; or a filed FinCEN Form 103
(CTRC ), IRS Form W-2G, (Certain Gambling
Winnings) (e.g., pertaining to a keno or slot win),
IRS form W-9 (Request for Taxpayer
Identification Number and Certification), or any
tax or other form containing such customer
information. If casinos do not have verified
identification information on the customer, they
should consult whatever other sources of customer
information that are available within internal
records (player rating records, slot club records,
etc.). If the subject is an “unknown,” casinos that
offer hotels including conference/seminar
facilities, entertainment venues, and resort
amenities should consider using whatever other
internal sources are available to obtain customer
identification such as credit/debit card numbers;
hotel registrations – e.g., guest folios, safe deposit
box registrations; show, spa, transportation and/
or tour reservations; etc.
Item 2 -- Multiple Subjects. If there are multiple subjects involved, check box “2a” and complete a separate Part I for each subject. Check box
“2b” only if NO critical* subject information is
available. If ANY subject information is available,
record that information in Part 1, leave box “2b”
blank, and insert the appropriate special response
“XX” in any critical item for which data is missing.
This will alert law enforcement and regulatory
users of the BSA database that this information
has not been inadvertently omitted.
Items *3, *4, and 5--Name of Subject. See
General Instruction B10. If the subject is an entity,
enter the legal name in item 3, enter XX in item 4
and leave item 5 blank. If the entity is operated
under a different trade or business name than its
legal name, enter the entity’s legal name in Item 3
(e.g., Smith Enterprises, Inc.) and the name of the
business in Item 6 (e.g., Smith’s Tours). If more
than one Part I is required, make a copy of page 1
and provide the additional information.
Item 6-- also known as (AKA-individual),
or doing business as (DBA-entity). If a

reporting casino or card club has knowledge of a
subject’s separate “AKA” or an entity’s DBA name,
enter it in item 6.
Item 7-- Occupation/type of business. Fully
identify the occupation, profession or business of
the individual or entity shown in Items 3 through
5 (e.g., accountant, attorney, carpenter, truck
driver, check casher, etc.). Do not use nondescript
terms such as merchant, self-employed,
businessman, or salesperson. If the subject’s
business activities can be described more fully than
just by occupation, provide additional information
in Part VI. Indicate in Item 7 if unknown.
Items *8, *9, *10, *11 and *12-- *Address.
See General Instructions B12 and B14.
Item 13-Vehicle license number
(optional). Enter the subject’s vehicle license
plate number and issuing state, if known or
available.
Item *14-- *SSN/ITIN (individual) or EIN
(entity). See General Instruction B11 and
definitions. If the subject named in Items 3
through 5 is a U.S. Citizen or an alien with a SSN,
enter his or her SSN in Item 13. If that individual
is an alien who has an ITIN, enter that number. If
the subject is an entity, enter the EIN. If unknown,
enter XX in the first two spaces.
Item *15-- *Account number. See General
Instruction B11. Enter the number of any account
in or through which the suspicious activity occurred.
If an account is not affected or if no affected
account is known, mark the “no account affected”
box. Check box to indicate if the account is open
or closed. If more than one account is affected,
provide the additional information in Part VI.
Item 16-- Date of birth. See General
Instruction B8. If an individual is named in Items
3 through 5, enter the date of birth. If t h e
month and/or day is not available or is unknown,
fill in with zeros (e.g., “01/00/1969” indicates an
unknown date in January, 1969).
Item *17-- *Government issued identification (if available). See General Instruction
B11. Check the appropriate box(es) showing the
type of document used to verify the subject’s
identity. If you check box “d” (Other), be sure to
specify the type of document used. In box “e” list
the number of the identifying document. In box
“f” list the issuing state or country. If more space
is required, enter the information in Part VI. If all
information for item 17 is unknown, check box
“d” and enter “XX” in the space proved for
“other.”
Items 18, 19-- Telephone numbers See
General Instruction B9 (telephone). List any
additional number(s) (e.g., hotel, cell, fax,
international etc.) in Part VI.

3
Item 20-- E-mail address List e-mail address
if available.

Part III Law Enforcement or Regulatory
Contact Information

Item 21-- Affiliation/relationship to casino.
If box “d” (employee) is checked, indicate in Part
VI the subject’s position (e.g., dealer, pit
supervisor, cage cashier, host, etc.) and the
subject’s involvement. If box “h” (other) is
checked, briefly describe in Part VI.

Note: If no contact, go to Part IV.

Items 22 and 23-- Continuing business
association
and/or
employer/employee
relationship. If the “no” box is checked, check
the appropriate box to indicate what action
occurred that ended the relationship. Indicate the
date that action was taken in Item 23 (see General
Instruction B8).
PART II Suspicious Activity Information*
Item 24-- *Date or date range of suspicious
activity. See General Instruction B8. Enter the
date of the reported activity in the “From” field.
If more than one day, indicate the duration of the
activity by entering the first date in the “From”
field and the last date in the “To” field. If the
same individual or organization conducts multiple
or related activities within the 30 calendar day
period after the date of initial detection, the
reporting institution may consider reporting the
suspicious transactions on one form but only if
doing so will fully describe what has occurred. A
new report must be filed for other related suspicious
transactions committed after the initial detection
period. “XX” may not be used in the “From” date
entry.
Item 25-- *Total dollar amount. See General
Instruction B13. Enter the total dollar value of
the funds or asset(s) involved in the suspicious
activity which is conducted by the same individual
or organization within the 30 calendar day period
after the date of initial detection. For multiple or
related suspicious transactions, show the breakdown
of this aggregated total in Part VI. For individual(s)
with a relationship to the casino (reference Item
21 “b“ through “h”), the value of this item can be
zero (0). Do not use any words, such as “thousand”,
“million”, etc. If unknown, enter “XX” right
justified.
Item 26-- *Type of suspicious activity. Check
the box(es), which best identify the suspicious
activity. If the activity involves exchanging
numerous small denomination bills for large
denomination bills at the cage, after the subject
engages in minimal or no gaming activity, check
boxes “e” and “f”. Check box “j” for Structuring
when a subject acting alone, in conjunction with,
or on behalf of other subjects, conducts or attempts
to conduct activity designed to evade any
recordkeeping or reporting requirement
promulgated under the Bank Secrecy Act. Check
box “o” if the ID presented does not match the
individual or if multiple ID’s conflict. If you check
box “q” for Other, you must describe, in Part VI,
the type of suspicious activity that occurred that
is not listed in Item 26. Use of “XX” does not
apply to this item. At least one box must be
checked.

Item 27, 28, and 29-- Contacting
enforcement
authorities.
See
General
Instructions “A. Abbreviations and Definitions”
for law enforcement and regulatory identities. If
the casino/card club has contacted any law
enforcement or regulatory agency about the
suspicious activity, by telephone or written
communication (excluding submission of a SARC),
check the appropriate box in item 27.
In Item 28 provide the name of the authority
contacted if box “b” or boxes “g” through “l” are
checked.
In Item 29, provide the name of the individual
contacted for all of box 27. Contact with law
enforcement agencies does not eliminate the
requirement to file the SARC.
Item 30-- Telephone number. See General
Instruction B9. Enter telephone number of the
individual listed in item 29.
Item 31-- Date contacted. See General
Instruction B8.
Part IV Reporting Casino or Card Club
Information*
Item *32-- *Casino or card club’s trade
name*. Enter the name by which the casino or
card club does business and is commonly known.
Do not enter a corporate, partnership, or other
entity name unless such name is the one by which
the casino is commonly known.
Item *33-- *Casino or card club’s legal
name. Enter the legal name as shown on required
tax filings, only if different from the trade name
shown in Item 32. The legal name should match
the name shown on the charter or other document
creating the entity, and which is identified with
the casino’s established employer identification
number.
Item *34-- *Employer identification
number. Enter the institution’s nine-digit EIN.
Items *35, *36, *37, and *38-- *Address.
See General Instruction B14.
Item 39-- Type of gaming institution. Check
the appropriate box for the type of gaming
institution. Check box “a” for a land-based or
riverboat casino that is duly licensed by a State,
Territory or Insular Possession of the United
States. Check box “b” for a tribal casino (i.e., a
Class III gaming operation). Check boxes “a” and
“b” for a tribal casino duly licensed by a state
gaming regulatory agency. Check box “c” for a
card club, gaming club, and card room or gaming
room (including one operating on Indian lands). If
you check box “d” for “Other”, be sure to specify
the type of gaming institution (e.g., race track).

Part V Contact for Assistance*
Items *40, *41, and 42-- *Contact
individual. See General Instruction B10.
Item *43 *Title/Position-- Enter the job title/
position of the contact individual.
Item *44 *Work phone number-- See
General Instruction B9.
Item *45 *Date report prepared-- See General
Instructions item B8.
PART VI *Suspicious Activity Information
-- Narrative. See FinCEN Form102, page 2 for
instructions.

Paperwork Reduction Act Notice: The purpose
of this form is to provide an effective means for
financial institutions to notify appropriate law enforcement agencies of suspicious transactions that
occur by, through, or at the financial institutions.
This report is required by law, pursuant to authority
contained in 31 U.S.C. 5318(g). Information collected on this report is confidential (31 U.S.C.
5318(g)). Federal securities regulatory agencies and
the U.S. Departments of Justice and Treasury, and
other authorized authorities may use and share this
information. Public reporting and record keeping
burden for this form is estimated to average 45
minutes per response, and includes time to gather
and maintain information for the required report,
review the instructions, and complete the information collection. Send comments regarding this burden estimate, including suggestions for reducing the
burden, to the Office of Management and Budget,
Paperwork Reduction Project, Washington, DC
20503 and to the Financial Crimes Enforcement
Network, Attn.: Paperwork Reduction Act, P.O.
Box 39, Vienna VA 22183-0039. The agency may
not conduct or sponsor, and an organization (or a
person) is not required to respond to, a collection
of information unless it displays a currently valid
OMB control number.