Provide details of the alleged fraud, waste, abuse or violation. Examples of facts and circumstances to include are: 1) a description of the misconduct; 2) how you know about the allegation; 3) how and when the misconduct was discovered; 4) the amount of money or property involved; 5) how long the alleged misconduct occurred; 6) attempts by the alleged violators to hide the misconduct; and 7) any other information you believe may be relevant.
Where did the misconduct occur: street address, city, state, etc?
Identify the primary person or entity who engaged in the alleged misconduct. If more than one person is involved, enter all identifying information including the company or organization they are associated with if a vendor or contractor.
Please provide any additional information concerning the misconduct, such as: 1) a list or description of any documents or other evidence you or others may have that is relevant to the complaint; 2) the names and contact information for other witnesses who can provide additional information; and 3) any other information you believe may be relevant to the complaint.
If you provide your first and last name, address, city, state, zip, e-mail, or phone, we will be able to contact you if we have questions and notify you upon conclusion of the investigation.
