Report Waste, Fraud, & Abuse Form

Name

First Name

Last Name

Phone

Street Address

Apartment, Suite, etc

City

State/Province

ZIP/Postal Code

When did the alleged waste, fraud, or abuse occur?

Which agency is involved?

What is the alleged employee or agent's title?

Who is the employee or agent that committed the alleged waste, fraud, or abuse?

What is the alleged waste, fraud, or abuse?

FCHR Acknowledgement

Yes

By selecting "Yes" I am acknowledging that my complaint and any other preliminary information available alleging a possible prohibited or retaliatory personnel action against me may be forwarded to the Florida Commission on Human Relations, without redaction, pursuant to Section 112.31895(1)(b), Florida Statutes. Selecting “No” may prevent the Office of the Chief Inspector General from forwarding my complaint and any other preliminary information alleging possible workplace retaliation against me to the Florida Commission on Human Relations for investigative purposes.

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