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Welfare Fraud Prevention Tip Form

Social programs are the safety net for every Alameda County family, in every neighborhood, in every community. Make sure nobody takes that safety net away. Report suspected welfare fraud today.

Please fill in as much information as possible. If you have only sketchy information, please send it to us anyway. It may be sufficient, in combination with other tips, to assist us.

This form is anonymous unless you choose to provide your information.

SUBJECT #1:

Name:
Home Address:
Work Address:
Other Address:
Telephone:  (Include cellular and pager numbers)
DOB:
Sex:
Height:
Weight:
Race:
Other Identifying Information:  (scars, tatoos, unique features, drugs involved, email address, etc.)
Vehicles:  (year, make, model, license plate number, etc.)
Allegations:  (Please indicate the fraud you believe is being committed by this individual. Be as specific as possible.)

SUBJECT #2: (not necessary to submit form)

Name:
Home Address:
Work Address:
Other Address:
Telephone:  (Include cellular and pager numbers)
DOB:
Sex:
Height:
Weight:
Race:
Other Identifying Information:  (scars, tatoos, unique features, drugs involved, email address, etc.)
Vehicles:  (year, make, model, license plate number, etc.)
Allegations:  (Please indicate the fraud you believe is being committed by this individual. Be as specific as possible.)

YOUR CONTACT INFORMATION: (optional)

This information is not necessary to submit a tip.

Name: (optional)
Telephone: (optional)
Email: (optional)

Leave this field empty



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