Do you have a case? Please complete this confidential form if you believe you have knowledge of fraud that has been, or is currently being, committed against the U.S. Federal Government. Answer all questions carefully and to your best ability so we may evaluate and determine if your potential case falls within our case requirements.
First Name Last Name
Email Phone
State Zip
Nature of the Fraud
When did the fraud begin?
 
Is the fraud still being continued?
Yes No  
 
When did the fraud cease?

,

 
Who / What is the entity committing the fraud?
An Individual
A Corporation
A Municipality
 
Name of Entity
 
Is your knowledge of the fraud first hand?
Yes No  
 
Do you possess any documentation about the fraud?
Yes No  
 
Do you know of any one who will agree with you?
Yes No  
 
Were / Are you an employee of the entity committing the fraud?
Yes No  
 
Have you reported the fraud to anyone in the entity?
Yes No  
 
Have you reported the fraud to the Federal Government?
Yes No  
 
If so, when?
,
 
Do you know, how much money is involved in the fraud?
Yes No  
 
If so, how much?
US$ Approx
 
Does anyone in the media have knowledge of this fraud?
Yes No  I don't Know  
How would you prefer to be contacted?
Phone Email  
Any pertinent information to determine if you have a valid case.
Remember : All data submitted are 100% confidential. We will communicate with you as soon as we have evaluated the information provided by you.

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