Reporting Fraud

It is important to report suspected Welfare fraud to ensure that County tax dollars are being used for their intended reason, which is to help those in need. By reporting suspected fraud, we ensure that there will be sufficient benefits available to help county residents in need of assistance. This is one of the most direct ways where every citizen can make a difference.

Optional information to be completed by the reporter.

First Name:

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City:

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State:

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Phone:

Enter a ten digit phone number with no spaces or hyphens.

Last Name:

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Street:

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Zip:

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Cell Phone

Enter a ten digit phone number with no spaces or hyphens.

E-mail:

Please enter a valid e-mail address.

Although the above information is not required, having your contact information will expedite the investigation if we should need additional information. Where you see an asterisk * below, that information is required.

Name of Person Receiving Assistance

First Name:(*)

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SS#:

(No dashes)

Last Name:(*)

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Date of Birth:

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Address of Person Receiving Assistance:

Street:(*)

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State:

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City:(*)

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Zip:

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What would you like to report? Please check all that apply.

1. Recipient or person in the household is working?

"On the Books"

"Off the Books"

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Name of person employed:

First Name:

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Name of Employer:

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City:

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Zip:

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Last Name:

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Employer Address:

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State:

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2. Recipient is not employed where reported.

Are they working somewhere else? (*)

Yes

No

This field is required.

Name of Employer:

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City:

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Zip:

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Employer Address:

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State:

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3. There is an unreported person living in the home. Name of person(s)

First Name:

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First Name:

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First Name:

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Last Name:

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Last Name:

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Last Name:

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How long has the person been living in the home?

Less than 12 monthsFrom 12-24 monthOver 24 months

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Is this person the parent of a child in the home?

YesNo

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Name of children:

First Name:

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First Name:

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First Name:

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Last Name:

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Last Name:

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Last Name:

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4. The recipient's children are no longer in the home. When did he/she move?

1st Child

Date:

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Where is the child currently living?

Street:

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State:

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City:

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Zip:

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2nd Child

Date:

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Where is the child currently living?

Street:

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State:

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City:

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Zip:

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3rd Child

Date:

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Where is the child currently living?

Street:

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State:

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City:

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Zip:

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5. Recipient owns the following vehicle:

Year:

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Model:

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License Plate #:

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Make:

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Color:

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Bank Account:

Name of Bank:

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State:

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If more space is needed, please complete in the additional info area below. (Example: a boat, stocks or bonds.)

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City:

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Zip:

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6. The recipient is receiving child support from the absent parent.
What is the absent parent's name?

First:

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Last:

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How much is he/she receiving?

$

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Per

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7. The recipient does not live where he/she says he/she is living.

New Street Address:

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State:

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City:

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Zip:

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When did they start living there?

Month:

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Year:

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8. Please include any additional information that you would like to share below

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Suspected Welfare Fraud Reporting