SSA Public Fraud Reporting Form

Fraud Reporting Form Need Larger Text?

You can use this online form to report allegations of fraud, waste, and abuse concerning SSA programs and operations. Our office also addresses allegations of criminal activity and serious misconduct involving Social Security employees. Moreover, we have jurisdiction to investigate allegations of work and assets concealment, representative payee misuse and trafficking of Social Security numbers and cards.

Quick Links

FAQS

Please Choose one (Required):

Confidentiality and Anonymity is not requested.
If necessary, you may contact me for additional information and I do not place any restrictions on the release of my contact information. Please fill out the contact form below.

I wish to remain Confidential.
You may contact me for additional information, but please keep my name confidential and do not share it outside of the Office of the Inspector General. Our policy is to honor requests for confidentiality and not to release any data that would identify such individuals unless required to do so by order of law (e.g., court order/subpoena). Please fill out the contact form below.

I wish to remain Anonymous.
If you choose to remain anonymous, it is not necessary to fill out the contact information. It is important to note that we will not be able to contact you if we need additional information about your complaint.

Section I Person or Business Reporting Fraud (Optional) Form Help
Are you filing as a Private Individual or on behalf of a Business? Private Individual Business
Section I-A - YOUR CONTACT INFORMATION
	E-mail address for an acknowledgement of your complaint
	Last Name
	First Name
	Middle Name / Initial
	Home Address
	City
	State
	Zip Code
	Home Phone
	Cell Phone
	Work Phone	Ext.
	Social Security Number
	Are you a victim of the alleged violation/fraud?	Yes No

Section I-B - YOUR BUSINESS INFORMATION (Skip this section if you completed Section I-A)
	Business Name
	Employer Identification Number
	Business Address
	City
	State
	Zip Code
	Business Phone
	Business Cell Phone
Section II Person Committing Fraud TOP of FORM
Are you reporting a Private Individual or a Business? Private Individual Business
Section II-A - Reporting a PRIVATE INDIVIDUAL If you are reporting more than one individual, please add your information in the Summary Section below.
	Last Name
	First Name
	Middle Name / Initial
	Alias
	Social Security Number
	Address
	City
	State
	Zip Code
	Home Phone
	Cell Phone
	Work Phone	Ext.
	Date of Birth	(MMDDYYYY)
	Sex
	Race
	State of Birth

Section II-B - Reporting a BUSINESS (Skip this section if you completed Section II-A) If you are reporting more than one business, please add your information in the Summary Section below.
	Business Name
	Employer Identification Number
	Business Address
	City
	State
	Zip Code
	Business Phone
	Business Cell Phone
Section III Primary Victim Information If you are reporting more than one victim, please add your information in the Summary Section below. TOP of FORM
	Last Name
	First Name
	Middle Name / Initial
	Address
	City
	State
	Zip Code
	Social Security Number
	Home Phone
	Cell Phone
	Work Phone	Ext.
Provide the following items if they apply:
	Date of Birth	(MMDDYYYY)
	Sex
	Race
Section IV Summary TOP of FORM
	Description - Please furnish the facts of the alleged fraud. Include who, what, when, where, how and why. Your description is limited to 4000 characters.

Message: If you do not enter this allegation in a timely fashion, you will be timed-out in 60 minutes,
lose your data and will be re-routed to the Public Fraud Reporting Home Page. Do not bookmark this page.


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	Last reviewed or modified Wednesday Aug 26, 2009