Report Welfare Fraud in Nevada


INVESTIGATIONS AND RECOVERY
CONCERNED CITIZENS REPORT


Use this form to report a client that has received benefits or has applied for benefits that you believe he/she is not entitled to. Examples of situations that may be considered fraudulent are: unreported income (working, gambling winnings, court settlements), hidden assets (such as bank accounts, property, etc.), unreported household changes (someone moved in/out), unreported changes in expenses (rent decrease), etc.


SECURITY WARNING

The information you have entered on this page will be sent over an insecure connection and could be read by a third party.

  

 Your name and phone number are optional and will be kept confidential, but it would be helpful to us in case we need to contact you for additional or clarifying information. May we contact you via e-mail?

                       

Personal Information

Your Name: 

Your Address: 

City, State: 

Your E-Mail Address: 

Your Area Code & Phone No. 

Who is the Complaint Against?

Client's Name: 

Client's Address: 

Client's City, State: 

Client's Date of Birth:   or Approximate Age: 

Social Security # (if known) 

Describe the Clients Vehicle

 

License Plate number(s)? 

Additional Information Regarding the Client

Who is living with the client? 

Relationship? 

Does anyone in this household work?

                   

If the client or someone else in the household is employed, please provide the following information: 

Name of person working: 

Employer's Name: 

Employer's Phone No:

Employer's Address: 

Employer's City & State: 

Does anyone in the household have other unreported income (such as child support, unemployment benefits, disability benefits, etc.)? 

If so, Who? 

Type of resource of resource? If resource is a vehicle, please describe and provide license plate number, if known:

 

Child or Children's Information

Child/ren's Name(s): 

Child/ren's Date of Birth(s): 

Child/ren's Social Security No. (if known): 

Describe the Situation or Actions by the Client you Believe to be Inappropriate or Illegal

 

Approximate Date it occurred (ex: March 2011 to December 2011)

Any Additional Information You Would Like to Add