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.

Complete and submit by mail or electronically

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