Elk in Rocky Mountain National Park
 

Welfare Fraud Complaint Form

Use this form to file welfare fraud complaints. Submit this only if the client has been issued benefits that you believe they were not entitled to. To ensure your complaint is investigated thoroughly, provide as much information below as possible. When finished, click the Submit Complaint button at the bottom.

A complaint may also be made by calling (970) 498-7635.

All fields with a red asterisk (*) must be entered.

Report Complaint Against
*Name: First: Last:
Also Known As: (other names used)
Street:
City:   State:   Zip:
Date of Birth:    OR   Age:
Social Security Number:
Driver's License:

Allegation

Describe how the client is committing welfare fraud, or trafficking in Food Stamps. State when the welfare fraud was committed. For example: mm/yyyy - mm/yyyy


Child Information 1
Name: First: Last:
Date of Birth:    OR   Age:
Social Security Number:

Child Information 2
Name: First: Last:
Date of Birth:    OR   Age:
Social Security Number:

Employer

If the client or someone else in his or her household is employed, please provide the information below.

Name: First: Last:
Employer Name:
Phone Number:
Street:
City:   State:   Zip:

Documents

You may upload and send up to 5 electronic documents, or send hardcopy documents to have included in the investigation.



Electronic Files:

Send hardcopy documents:

  • Fax: (970) 498-7625
  • Mail:
    Larimer County Department of Human Services
    ATTN: Fraud Investigations
    2601 Midpoint Drive, Suite 112
    Fort Collins, CO 80525

Complainant Information - Optional

You can submit this anonymously or if you agree to be contacted, complete the section below.

Yes, please contact me
No, do not contact me

Name: First: Last:
Email:
Phone Number:
Street:
City:   State:   Zip:

Background Image: Rocky Mountain National Park by Sue Burke. All rights reserved.