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Office of the General Counsel Fraud Report Form

Fill out the fields below to report suspected or known fraud. Include as much information as possible.

You may remain anonymous if you wish. However, if you choose not to provide your contact information, it may hinder the investigation if questions arise during the review process.

Information about the person who has or may be committing fraud

^*Indicates Required Fields

First Name^*

Last Name^*

Alias or Nickname

Address

City^*

State^*

Zip Code

Estimated Age^*

Phone

Family or Household Make Up

Number of Children

Children First and Last Names

Schools

Other Adults Living in Household
(First and Last Names)

Employment (Current or Last Known)

Employer Name

Employer Address

Absent parent who is living in the home

First Name

Last Name

Gender

Male

Female

Age

Employer Name

Employer Address

Please enter all the information you have regarding the known or suspected fraud

Attach Files
*File size should be less than 50MB.
*Allowed file types: .doc;.docx;.pdf;.txt;.xlsx;.jpg;.png;.jpeg; only.
*Do not use special characters(like #,$,%,@,*,/..)in the file name.

Please enter your information

Do you wish to remain anonymous?

First Name

Last Name

Address

State

Zip Code

Daytime Phone

Evening Phone

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Office of the General Counsel Fraud Report Form