Fraud Reporting Instructions

Section I - Person or Business Reporting Fraud Instructions

Section I-A - Your Information

The information provided in this section is about the person reporting the fraud.

Please keep in mind that if you choose to remain anonymous, our inability to contact you may limit our ability to conduct a complete investigation.

Email address for an acknowledgement of your complaint.

Last Name - Enter last name - format (40 characters).

First Name - Enter first name - format (20 characters).

Middle Name / Initial - Enter middle name or initial - format (20 characters).

Address - Enter mailing address - format (30 characters).

City - Enter city name - format (30 characters).

State - Click on the dropdown arrow. Select appropriate state from the dropdown list - list contains 50 states, District of Columbia, Puerto Rico and the Virgin Islands.

Zip Code - Enter zip code - format (10 characters numbers only no dashes).

Home Phone - Enter home phone number - format (10 characters numbers only no dashes).

Cell Phone - Enter cell phone number - format (10 characters numbers only no dashes).

Work Phone - Enter work phone number - format (10 characters numbers only no dashes).

Social Security Number - Enter social security number - format (9 characters numbers only no dashes).

Are you a victim of the alleged violation/fraud?

Section I-B - Your Business Information

Business Name - Enter the name of business - format (35 characters).

Employer Identification Number - Enter employer identification number - format (11 characters).

Business Address - Enter the business mailing address - format (30 characters).

City - Enter business city name - format (30 characters).

State - Click on the dropdown arrow. Select appropriate state from the dropdown list - list contains 50 states, District of Columbia, Puerto Rico and the Virgin Islands.

Zip Code - Enter the business zip code - format (10 characters numbers only no dashes).

Business Phone - Enter the business phone number - format (10 characters numbers only no dashes).

Business Cell Phone - Enter the business cell phone number - format (10 characters numbers only no dashes).

Section II - Person Committing Fraud Instructions

Section II-A - Reporting a Private Individual

The information provided in this section is about the person who you believe committed the fraud.

Last Name - Enter last name - format (40 characters).

First Name - Enter first name - format (20 characters).

Middle Name / Initial - Enter middle name or initial - format (20 characters).

Alias - Enter other name which person may be using - format (35 characters).

Social Security Number - Enter social security number - format (9 characters numbers only no dashes).

Address - Enter mailing address - format (30 characters).

City - Enter city name - format (30 characters).

State - Click on the dropdown arrow. Select appropriate state from the dropdown list - list contains 50 states, District of Columbia, Puerto Rico and the Virgin Islands.

Zip Code - Enter the business zip code - format (10 characters numbers only no dashes).

Home Phone - Enter home phone number - format (10 characters numbers only no dashes).

Cell Phone - Enter cell phone number - format (10 characters numbers only no dashes).

Work Phone - Enter work phone number - format (10 characters numbers only no dashes).

Date of Birth - Enter date of birth - format (8 characters numbers only mmddyyyy).

Sex - Click on dropdown arrow. Select appropriate gender from the dropdown list - list contains the following valid values - Female or Male.

Race - Click on dropdown arrow. Select appropriate race from the dropdown list - list contains the following valid values - Asian, Black, Hispanic, NA Indian/Alaskan, Other, White or Unknown.

State of Birth - Click on the dropdown arrow. Select appropriate state from the dropdown list - list contains 50 states, District of Columbia, Puerto Rico and the Virgin Islands.

Section II-B - Reporting a Business

Business Name - Enter name of business which you are reporting - format (35 characters).

Employer Identification Number - Enter employer identification number - format (11 characters).

Business Address - Enter business mailing address - format (30 characters).

City - Enter business city name - format (30 characters).

State - Click on the dropdown arrow. Select appropriate state from the dropdown list - list contains 50 states, District of Columbia, Puerto Rico and the Virgin Islands.

Zip Code - Enter the business zip code - format (10 characters numbers only no dashes).

Business Phone - Enter business phone number - format (10 characters numbers only no dashes).

Business Cell Phone - Enter business cell phone number - format (10 characters numbers only no dashes).

Section III - Primary Victim Instruction

The information provided in this section is if the victim is someone other than you.

Last Name - Enter last name - format (40 characters).

First Name - Enter first name - format (20 characters).

Middle Name / Initial - Enter middle name or initial - format (20 characters).

Address - Enter mailing address - format (30 characters).

City - Enter city name - format (30 characters).

State - Click on the dropdown arrow. Select appropriate state from the dropdown list - list contains 50 states, District of Columbia, Puerto Rico and the Virgin Islands.

Zip Code - Enter zip code - format (10 characters numbers only no dashes).

Social Security Number - Enter social security number - format (9 characters numbers only no dashes).

Home Phone - Enter home phone number - format (10 characters numbers only no dashes).

Cell Phone - Enter cell phone number - format (10 characters numbers only no dashes).

Work Phone - Enter workphone number - format (10 characters numbers only no dashes).

Date of Birth - Enter date of birth - format (8 characters numbers only mmddyyyy).

Sex - Click on dropdown arrow. Select appropriate sex from the dropdown list - list contains the following valid values - Female or Male.

Race - Click on dropdown arrow. Select appropriate race from the dropdown list - list contains the following valid values - Asian, Black, Hispanic, NA Indian/Alaskan, Other, White or Unknown.

Section IV - Summary

Description - Please furnish the facts of the alleged fraud. Include who, what, when, where, how and why. Your description is limited to 50 lines.

Form Actions - Buttons Instructions

Submit Form
When you have completed all pertinent information on the Public Fraud Reporting Form, press the Submit Form button to submit the allegation. If an error is detected, you will get an error message. Read the error message and click the OK button - you will be taken to the field where the error occurred.

Reset
This action will remove any data that you have entered on the allegation form. This will allow you to start over with a 'fresh' allegation form. Any data you have entered will be lost.