Unemployment Insurance Benefit Fraud Information

* Note: Providing your name, phone number and email address are optional, but very helpful. You may remain anonymous by not completing those items.

* Your name, phone and email:

* Name:         

* Phone Number: 

* Email:         john.doe@yourdomain.com

Please provide any known information on the fraudulent case below:

To be sure that we are able to adequately investigate your allegation, be sure to include as much of the following information as possible. If you do not know the answer, don't worry, just tell us what you do know.

Claimant Information

Who is committing fraud?:        

What is their full address?:     

Their Social Security number?:   

Their phone number?:             

What are they doing? (working? running a business? living in another country? unable to work?):

                                 
                       
When did they start doing this?:

If they are working -

   
What is the employer's name?:         

Where is the employer located?:       

What is the employer's address?:      

What is the employer's phone number?: 

Is the employer helping the claimant to commit fraud?: YES  NO  Don't Know 

     And if so, how?  (Paying in cash, banking work hours, paying unemployment as part of their wages, etc.?)

Who else knows about it?:

Any other information that you would like to provide?