Report Fraudulent Activity

To report fraudulent activity, please complete the form below. In order to assist with our investigation, supply all the information that is known to you.
   
Claimant's Name  
Social Security Number  
Street Address  
 
City   State   Zip  
Name of Alleged Employer  
Address of Alleged Employer  
Method of Payment Payroll Off the Books
How Long Has Claimant Been Working for Alleged Employer?
Years   Months   Weeks  
Claimant's Occupation  
Explain the Fraudulent Activity