Report Fraud · Customer Self-Service

Overview

Subject

Your Information

I wish to remain anonymous

Please provide your phone number or email address in case we need more information.

Complaint Type

First Name

Last Name

Email Address

Relationship

Telephone Number

Cell Phone Number

Street 1

Street 2

Street 3

City

State

Zip Code

Agency

Agency ID

Person You Are Reporting

First Name

Last Name

Street 1

Street 2

Street 3

City

State

Recipient Zip Code

Date of Birth

Approximate Age

Social Security Number

Driver's License Number

Client ID Number

List Any Children Involved

Additional Persons or Organizations Involved

Programs (if known)

Examples of programs we investigate are CalWORKs, CalFresh, CAPI, General Assistance, and IHSS.

Suspected Fraud Details

What is the Suspected Fraud?

Suspected Fraud Description

Other

Has this complaint already been submitted elsewhere?

NoYes

If yes, to what person or agency? (Describe)

Attachments

Please provide a description of the attachments.

Attach a file