Social Security Fraud Report Form
Report suspected social security fraud incidents. Your information helps protect community resources. You may choose to remain anonymous.
Would you like to remain anonymous while submitting this report?
*
Yes, I want to remain anonymous
No, I am willing to provide my contact information
Your Full Name (if not anonymous)
First Name
Last Name
Your Email Address (if not anonymous)
example@example.com
Your Phone Number (if not anonymous)
Please enter a valid phone number.
Format: (000) 000-0000.
Are you reporting as an individual or on behalf of an organization?
*
Individual
Organization
Name of the person or organization suspected of fraud (if known)
Type of suspected fraud
*
Please Select
Benefit fraud
Identity theft
False claim
Unreported income
Other
Date the suspected fraud occurred (or date discovered)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of the suspected fraud (city, state, or address if known)
Please describe the suspected fraud in detail
*
Upload any supporting evidence or documentation (optional)
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