Form – Components and Variants

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request assistance

Please fill out the form below to connect with our team. We’ll reach out promptly to provide the support you need.

"*" indicates required fields

Name*

Phone Number*

Defendant’s name (if known)

CC number (if known)

Email Address*

Preferred Contact Method*

Details of your case/inquiry*

*Required Fields

1Basic Information

2Case Background

3Claims & evidence

4Additonal information & affirmations

Are you requesting a review of a criminal conviction that arose from proceedings in Suffolk County?(Required)

Yes

The Suffolk County District Attorney only has jurisdiction to review criminal proceedings in Suffolk County. Please contact the county of jurisdiction.

Are you requesting a review on behalf of your own conviction or someone else’s?(Required)

For me

For someone else

Have you been authorized by that individual to do so?(Required)

Yes

What is the nature of authorization?(Required)

Retained attorney

Estate/Power of Attorney

Other

Is the individual still incarcerated as a result of this particular conviction?*(Required)

Yes

Has an appeal or other post-conviction motion been filed?*(Required)

Yes

What was the outcome?(Required)

Denied

Still pending

Other

State the exact nature of post-conviction appeal or motion.(Required)

Please fill out the following information.

First & Last Name*(Required)

Phone Number *(Required)

Email Address*(Required)

Date of Birth*(Required)

MM slash DD slash YYYY

Current Address

Inmate Number: (If applicable)

Case number of conviction to be reviewed

Date of Conviction

MM slash DD slash YYYY

Do you have a lawyer?(Required)

Yes

Lawyer Name(Required)

Lawyer Address(Required)

Lawyer Phone Number(Required)

What is your primary language?(Required)

Is there any reason corresponding in writing will be difficult for you?(Required)

Yes

Have you ever received mental health treatment?(Required)

Yes

Has anyone assisted you in filling out this form?(Required)

Yes

Please provide names, addresses, and phone numbers of family or friends who might have information regarding your case.

I am giving consent for the SCDA to contact these individuals(Required)

Yes

Please provide a brief factual background describing the circumstances of the crime(s) for which you were convicted

Are you claiming actual innocence (meaning that you were not involved in the crime in any way)?*(Required)

Yes

Don't Know

Please explain why you believe that you are innocent of this crime (this cannot be self-defense or insanity)(Required)

Are you claiming wrongful conviction (meaning that evidence used against you at trial was inaccurate or unreliable or that the trial was fundamentally unfair)?*(Required)

Yes

Please explain why you believe that you were wrongfully convicted(Required)

Are you requesting DNA, fingerprint, or other forensic testing of evidence from the crime?*(Required)

Yes

Please explain what you would like tested and why it would further your claim.(Required)

Did you have any co-defendants?*(Required)

Yes

Identify each and provide any contact information.(Required)

Are you claiming your co-defendants were innocent or wrongfully convicted?(Required)

Yes

Were there any other people involved in the commission of the crime who were not prosecuted or convicted?*(Required)

Yes

Identify them.(Required)

Explain their role.(Required)

Please identify any additional witnesses who would support your claim. For each, include their name, contact information, and what the person knows about your claim.

Was any scientific or forensic evidence used to convict you?*(Required)

Yes

Please describe this evidence(Required)

Did any police informants testify against you?*(Required)

Yes

Was their testimony truthful? If not, please explain why(Required)

Did you confess to the crime?*(Required)

Yes

Please describe the circumstances(Required)

Was an eyewitness identification used against you?*(Required)

Yes

Please explain the circumstances(Required)

Do you know who committed the crime for which you were convicted? *(Required)

Yes

Identify and Explain.(Required)

Did you plead guilty to the crime(s) of which you were convicted? *(Required)

Yes

Please provide any further information you want the SCDA to know that would help your claim

Please accept the following affirmations.

All statements herein are true and accurate*(Required)

Yes

I acknowledge false information provided to SCDA will result in rejection of my application for review*(Required)

Yes

I acknowledge that I have no right to this review and there is no right to appeal rejection of my application*(Required)

Yes

I understand that the SCDA is not my attorney*(Required)

Yes

I am willing to cooperate with the SCDA investigation into my conviction*(Required)

Yes

I understand that the SCDA may reject my application for review at any time*(Required)

Yes

I understand that this is not a legal appeal*(Required)

Yes

I understand that this application will not extend any deadlines for appeal or other post-conviction remedies under the Criminal Procedure Law.(Required)

Yes

*Please complete the CAPTCHA

contact the district attorney’s office

Select your reason for contacting us. Choose a topic, and the form will appear automatically

Please complete this form to the best of your ability.

Please select a topic(Required)

Who committed the misconduct?(Required)

Government Official

Police Officer

Did one or more of the incidents you are reporting take place in Suffolk County?(Required)

Yes

I don't know

Did you personally experience or witness an act or acts of misconduct by one or more law enforcement officers?(Required)

Yes

Did the incident involve the following type(s) of misconduct? Select all that apply(Required)

Excessive Force

Improper Search

Theft of Personal Property

Improper Stop

Improper Arrest

Other

Was anyone arrested or given a summons in connection with the incident you are reporting?(Required)

Yes

I don't know

Who was arrested or given a summons, if you know? Select all that apply(Required)

I was arrested

Other(s) were arrested

I was given a summons

Other(s) were given a summons

Please identify the law enforcement officer(s) involved by name, shield number, squad car number, precinct, and law enforcement agency, or by physical description, to the best of your ability. A shield number is the number that appears on an officer’s badge(Required)

Did you, or another person, make a 911 call relating to this incident?(Required)

Yes, I made a 911 call

No, no one made a 911 call

Yes, someone else made a 911 call

I do not know if anyone made a 911 call

Please identify the government official(s) involved by name.(Required)

Have you previously reported this misconduct to the District Attorney's Office?(Required)

Yes

Have you reported this incident to another agency? select all that apply(Required)

Yes, I reported it to the Suffolk County Police Department (SCPD)

Yes, I reported it to the Internal Affairs Bureau (IAB)

Yes, I reported it to the New York Attorney General's office (NYAG)

Yes, I reported it to an agency not listed here

No, I have not reported it to any other agency

If you answer yes, please indicate which ones.

Please provide a brief description of the incident of misconduct, including the date, time, and location, to the best of your ability. You may include more than one incident, if applicable(Required)

In case of emergency, please call 911.

Subject Information

Subject Name/Nickname

Phone Number

Email Address

Address

City

State

Zip Code

Have you reported this complaint to any other law enforcement agencies?(Required)

Yes

If you answer yes, please indicate which ones.(Required)

How will you submit the report?

Please state your complaint clearly and concisely in the textbox below. Provide a factual summary of events. Be specific. Where appropriate include relevant dates, times and locations as well as the name, address and phone number of any person known to have information or evidence related to your complaint.

Your Message(Required)

How will you submit the report?(Required)

I would like to remain anonymous to all but law enforcement personnel.

My contact information is below.

Your information will not be disclosed during course of investigation. However, please note that if the matter proceeds to an arrest or public filing, and you are deemed to be an essential witness, the SCDA cannot guarantee your continued anonymity.

Your contact information

First Name(Required)

Last Name(Required)

Email Address(Required)

Phone Number(Required)

Address

City

State

Zip Code

NOTICE: Pursuant to section 240.50 of the New York State Penal Law, it is a crime punishable as a class A misdemeanor to falsely report an incident. Furthermore, pursuant to section 210.45 of the New York State Penal Law, it is a crime punishable as a class A misdemeanor to knowingly make a false statement in this complaint.

I have read and acknowledge the above information(Required)

I have read and acknowledge the above information

Please sign this form by printing your full name(Required)

Please select today's date(Required)

MM slash DD slash YYYY

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CAPTCHA

Please complete the CAPTCHA

Please select a topic(Required)

In case of emergency, please call 911.

Information for U-Visa Application

Name of Applicant(Required)

Applicant Date of Birth

MM slash DD slash YYYY

Was an arrest made?(Required)

Yes

Defendant Name(Required)

Defendant's Date of Birth(Required)

MM slash DD slash YYYY

Defendant Docket Number(Required)

Defendant CC Number

This field is hidden when viewing the form

Your message(Required)

Case Information

To learn when a criminal case is next scheduled to be heard, please visit the New York State Unified Court System’s Case Search Web Platform. To learn information about your case, please fill in as many fields as possible below.

Defendant First Name

Defendant Last Name

Location of Incident

Date of Incident

MM slash DD slash YYYY

Docket Number

Indictment Number

Your contact information

First Name(Required)

Last Name(Required)

Email Address(Required)

Phone Number(Required)

Address

City

State

Zip Code

CAPTCHA

Please select a topic(Required)

This field is hidden when viewing the form

Section Break

Request # (enter exactly as received)(Required)

Invite the DA to your event

If you are a community, religious or business organization and would like the DA or his Executive team to attend your upcoming event, please submit the details below at least four weeks in advance.

Organization Name(Required)

Event Date(Required)

MM slash DD slash YYYY

Event Start Time

MM slash DD slash YYYY

Event End Time

MM slash DD slash YYYY

Will the DA or Exec team have a speaking role at the event?

Yes

What is the topic of the talk?

This field is hidden when viewing the form

Section Break

Your message(Required)

Your contact information

First Name(Required)

Last Name(Required)

Email Address(Required)

Phone Number(Required)

Address

City

State

Zip Code

Please complete the CAPTCHA

Form – Components and Variants

request assistance

The Suffolk County District Attorney only has jurisdiction to review criminal proceedings in Suffolk County. Please contact the county of jurisdiction.

contact the district attorney’s office

Subject Information

How will you submit the report?

Your contact information

CAPTCHA

Information for U-Visa Application

Case Information

Your contact information

Section Break

Invite the DA to your event

Section Break

Your contact information

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