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Reporting Suspected Fraud

Complaint Form

Please provide complete information to the best of your knowledge. Information that you enter here is held confidential until a case reaches a Court Hearing. You may remain anonymous by not including your personal information. However, we request that you include contact information so we may review or clarify information you have supplied.

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Personal Information [Optional]
'Recipient in receipt of assistance'
Problem/s: check appropriate and fill in information
Actually lives at
Unreported person/s in Home
$ /Hour
$ /Week
Unreported income
$ /Hour
$ /Week
Unreported Resources
Owns Vehicle
Owns property
Lawsuit Award