"Fraud Report Information Sheet" - Alabama

Fraud Report Information Sheet is a legal document that was released by the Alabama Department of Labor - a government authority operating within Alabama.

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Download "Fraud Report Information Sheet" - Alabama

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INFORMATION SHEET
The Alabama Department of Labor will investigate all reports of fraud provided that evidence is
sufficient to proceed. Your identity will be held in strict confidence.
Name of person making complaint/referral:____________________________________________
Address;_________________________City:____________State:______ Zip Code: ___________
Phone Number:______________
Name of person you are reporting:___________________________________________________
Social Security Number:_________________
Occupation:____________________
Home Address:_________________________City:____________State:______Zip Code:_______
Phone Number:______________D.O.B.:__________Sex:_____
Alleged Employer:_______________________________________________________________
Employer Address:______________________City:____________State:______Zip Code:_______
Employer Phone Number:________________
Work Site (if different from Above):__________________________________________________
Work Schedule:_________________________________________________________________
How long has referral been working for alleged employer?_________________________________
Method of payment ______ on payroll ______ off books
Name of previous employer:________________________________________________________
Address:_________________________City:____________State:______Zip Code:____________
Reason for referral or why fraud is suspected:
Mail to: Alabama Department of Labor
Benefit Payment Control Section, RM 3675
649 Monroe St.
Montgomery Ala 36131
INFORMATION SHEET
The Alabama Department of Labor will investigate all reports of fraud provided that evidence is
sufficient to proceed. Your identity will be held in strict confidence.
Name of person making complaint/referral:____________________________________________
Address;_________________________City:____________State:______ Zip Code: ___________
Phone Number:______________
Name of person you are reporting:___________________________________________________
Social Security Number:_________________
Occupation:____________________
Home Address:_________________________City:____________State:______Zip Code:_______
Phone Number:______________D.O.B.:__________Sex:_____
Alleged Employer:_______________________________________________________________
Employer Address:______________________City:____________State:______Zip Code:_______
Employer Phone Number:________________
Work Site (if different from Above):__________________________________________________
Work Schedule:_________________________________________________________________
How long has referral been working for alleged employer?_________________________________
Method of payment ______ on payroll ______ off books
Name of previous employer:________________________________________________________
Address:_________________________City:____________State:______Zip Code:____________
Reason for referral or why fraud is suspected:
Mail to: Alabama Department of Labor
Benefit Payment Control Section, RM 3675
649 Monroe St.
Montgomery Ala 36131