Form to Report Unemployment Fraud

The Great Seal of the State of New Jersey

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.

Investigation Information
**
(First, Middle, Last)
-- (xxx-xx-xxxx)
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
**
**

(** indicates a required field)

Page 1 of 1