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What is Fraud, Waste, and Abuse
Fraud/Waste/Abuse Allegation Form
Step 1 of 6
1. What type(s) of fraud, waste, or abuse are you reporting? (Check all that apply.)
Theft or misuse of State resources
Purchasing or procurement
Contract or grant management
(Intentional or unintentional, thoughtless, or careless expenditure, consumption, mismanagement, use, or squandering of State resources. Waste also includes incurring unnecessary costs because of inefficient or ineffective practices, systems, or controls.)
Government Auditing Standards
defines abuse as behavior that is deficient or improper when compared with behavior that a prudent person would consider reasonable and necessary business practice given the facts and circumstances. Abuse also includes misuse of authority or position for personal financial interests or those of an immediate or close family member or business associate.)
2. Which State government agency or entity is involved in your allegation?
Agriculture and Rural Development
Civil Service Commission
Health and Human Services
Insurance and Financial Services
Licensing and Regulatory Affairs
Military and Veterans Affairs
Secretary of State
Talent and Economic Development
Technology, Management, and Budget
Other (list below)
Other State government agency or entity:
3. Does your allegation involve an individual person or entity doing business with a State agency, such as a contractor or grant recipient?
4. Name and position of the person(s) involved in the inappropriate activity:
5. When did the suspected loss or inappropriate activity occur?
6. Do you believe the suspected loss or inappropriate activity is still occurring?
7. What is the suspected amount of loss, if any?
8. Use as much detail as possible to describe the activity that you believe was inappropriate (include what, where, why, and how):
9. Please identify any specific law, rule, or other standard you think this activity violated:
10. When and how did this activity come to your attention?
11. Do you have any documentation or evidence to provide that supports your allegation?
Documentation can be invoices, vouchers, receipts, payroll records, etc. Describe the specific items we should review and provide copies. Copies may be scanned and uploaded using the buttons below or mailed to the address at the end of this form.
12. Has your allegation been reported to any other individuals or entities, such as department management, a law enforcement agency, a lawyer, or others?
If yes, please provide the name of the individual or entity, date filed, tracking number (if available), and status to date or outcome (if known).
13. Please provide identifying information for anyone else who may have witnessed or be aware of the incidents being described (name, e-mail address, phone number, etc.):
14. If there is any other information useful to our review of your allegation that has not already been submitted, please provide it below:
Optional Information About You:
Address Line 2
What is the best time frame for us to contact you if we need to?
Specific time frame:
What is the best method for us to contact you if we need to?
This field is for validation purposes and should be left unchanged.