Fraud Hotline Report Form

Please note: This Form is for reporting information concerning fraud, waste or abuse in Chambers County programs or operations.

Complainant Contact Information (Optional):
Please give a very detailed description of the incident especially in cases where the complainant remains anonymous.

First and Last Name (Optional):
Your answer
Home Phone (Optional):
Your answer
Email Address (Optional):
Your answer
Date of Incident:
Please be as specific as possible if you are unsure.
Date of Incident: *
MM
/
DD
/
YYYY
Information Concerning Person or Persons Involved in the Incident:
Please Be very specific and give all of the information you can including the name and job title of the person(s) if known:
Person(s)Involved: *
Your answer
Detailed Description of the Incident:
Remember, if you are remaining anonymous we will not be able to contact you so please give very specific facts about the incident.
Detailed Description: *
Your answer
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