EBT Fraud Report Form
Report suspected misuse, theft, or unauthorized use of EBT benefits or card activity. Please provide as much detail as possible. Do not include sensitive information such as full card or government ID numbers.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Your Relationship to the Case
*
Please Select
Self
Family Member
Friend/Acquaintance
Community Member
Agency/Organization
Other
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident (Address, Store, or Description)
*
Benefit or Card Use Affected (select all that apply)
SNAP
Cash Assistance
Other Benefit
Last 4 digits of EBT card (if known)
Type of Suspected Fraud
*
Unauthorized Use
Theft or Stolen Card
Selling/Trading Benefits
Providing False Information
Other
Describe What Happened
*
Names or Descriptions of People Involved (if known)
Upload Supporting Evidence (images, documents, etc.)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Preferred Method of Follow-Up
*
Email
Phone
No Follow-Up Needed
Submit Report
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