Report Fraud > Other fraud, waste, or misconduct

BSI Complaint Form


 

The Office of Inspector General works to maintain public confidence in government by combating fraud, waste, misconduct, and abuse in Commonwealth programs, operations, and contracts.

To report suspected fraud, waste, misconduct or abuse involving a person, please provide as much of the following information as possible. The more information you provide, the more thorough any investigation may be.

Please note that this complaint can be against a person and/or an agency/business.

Note that fields marked with a red asterisk (*) must be completed in order for the complaint to be processed.

 
The following section pertains to the subject of the complaint:
First Name
Middle Name or Initial
Last Name
Nickname(s)
Other names
Address
City
State
Zip Code
Date of Birth  
Approximate Age (if DOB unknown)
Driver's License Number
Issusing State of Driver's License
License Plate Number
Issuing State of License Plate
Vehicle Description (Make, Model, Year, Color)
Others Involved
Employer
Position Title
Employer Address
Employer City
Employer State
Employer Zip
Business Name
Business Owner
Business Address
Business City
Business State
Business Zip
Business Telephone
Business Hours of Operation
Explain the Complaint*
Date and Time Violation was Observed  
The following section asks for your contact information:
Your Name
Your Address
Your City
Your State
Your Zip
Your Telephone Number
Your Email

 

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Supporting documentation may be faxed with a cover letter indicating the related complaint to the Office of Inspector General at (717) 787-7921