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Unemployment Tax Fraud Questionnaire
Use this form to report employers committing fraud against the Pennsylvania UC program.
You are on page 1 of 1. There are 9 questions to answer on this page.
Your personal information is optional, but would enable an investigator to contact you if additional information is needed. If you provide your name and telephone number, and want to remain anonymous, your identity will not be disclosed unless legally required.
Your telephone number:
Would you prefer to remain anonymous?
Do you wish to be contacted by an investigator?
Please supply as much of the following information as you can.
Employer Telephone Number:
Affected employee(s) name(s):
Explain in detail what the employer is doing to circumvent the unemployment system. Please include worksites, method of payment to workers, type of work, and any other information which you believe is important.
Department of Labor & Industry
Commonwealth of Pennsylvania. All Rights Reserved
DATE/TIME:Dec 13, 2013 4:36:38 AM