"Fraud Reporting Form" - Kansas

Fraud Reporting Form is a legal document that was released by the Kansas Department of Labor - a government authority operating within Kansas.

Form Details:

  • The latest edition currently provided by the Kansas Department of Labor;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Kansas Department of Labor.

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Download "Fraud Reporting Form" - Kansas

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KS Workers Compensation
Fraud Reporting Form
CONFIDENTIAL
You may choose to submit this form anonymously, however this may limit the scope of the investigation.
Your Name
Address
Phone
SSN:
Name of Person or Entity Suspected of Committing Fraud
Address
Phone
SSN:
DOB
DL
Other
Person the Act was Committed Against
Address
Phone
SSN:
DOB
DL
Other
County in which the accident occurred
Date of Accident
Today's Date
Details
KS Workers Compensation
Fraud Reporting Form
CONFIDENTIAL
You may choose to submit this form anonymously, however this may limit the scope of the investigation.
Your Name
Address
Phone
SSN:
Name of Person or Entity Suspected of Committing Fraud
Address
Phone
SSN:
DOB
DL
Other
Person the Act was Committed Against
Address
Phone
SSN:
DOB
DL
Other
County in which the accident occurred
Date of Accident
Today's Date
Details