Welfare Fraud Business Complaint Form

The Office of Inspector General is strongly committed to identifying and eliminating fraud against a business, vendor, or provider, such as retail food outlet or medical provider that allows a person to sell his food stamp benefits in exchange for cash.

A complaint should be completed only if you believe the business is involved in welfare fraud. To ensure that your complaint is investigated thoroughly, please provide as much of the following information as possible.

Note: All fields with a red asterisk (*) must be completed for the complaint to be processed.

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Please correct the following errors:

Business Name: Owner's First Name: Owner's Last Name: Business Address: Business City: Business State: Business Zip Code (5 digits): Explain the Complaint:

The following information is optional. You may choose to remain anonymous, however, entering your contact information below allows the OIG to contact you in the event additional information is required regarding your tip.

Your Name: Your Address: Your City: Your State: Your Zip Code (5 digits): Your Telephone Number (format: 555-555-5555): Your Cell Phone (format: 555-555-5555): Your Email Address: