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Fraud Allegation Form

1

Type of Fraud

2

Details

3

Complete

Submitting the same referral multiple times will not expedite the process

We are currently processing all referrals in the order in which they are received

We kindly ask for your patience as we work through each submission with care and attention.

Are you reporting any of these circumstances

Are you reporting any of these entities?

You can also report to our hotline (401) 574-8175 but it will take us longer to process it. Please do not submit the same referral to both the hotline and web form or submit the same referral more than once, this will delay the review of your referral.

Is your complaint related to the following state benefit(s)?

Programs

Someone stole my/someone else state benefits

Who are you reporting?

Child Care or Health Care Provider Misconduct

Who are you reporting?

Store or State Vendor Misconduct

Who are you reporting?

State Agency or Employee Misconduct

Who are you reporting?

Providing False or Misleading Information to obtain state benefits

Providing False or Misleading Information

Do you know who?

Failing to Report Changes while obtaining state benefits

What changes were not reported?

Receiving benefits from multiple states or programs simultaneously

State

State Program

Do you know if they use the same or different (possible stolen) identities to obtain benefits for multiple state / programs

Select Identity

Buying/Selling or Misuse of state benefits

Please identify the fraud scheme

Are any of the following cards being used by the holder?

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