COUNTY OF SUFFOLK
SUFFOLK COUNTY EXECUTIVE
DEPARTMENT OF SOCIAL SERVICES
Request for Investigation of Welfare Fraud
Required fields are marked with an *.
* Client First Name:
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* Client Mailing Address Line 1:
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* Client Last Name:
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Client Mailing Address Line 2:
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Client Phone Number: xxx-xxx-xxxx
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* Client City:
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Client Date of Birth: MM/DD/YYYY
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* Client State:
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* Client Zip:
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* Description of Alleged Fraud (Max Characters 1000):
Note: Please include information that would assist Investigators: For example, description of client,
places of suspected employment, source of benefits or compensation, assets, bank accounts,
description of absent parent, activity and employment, description of car(s) and license number(s).
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The following fields are
REQUIRED
when submitting this form online.
* Your First Name:
* Your Last Name:
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*
*
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* Your Phone: xxx-xxx-xxxx
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* Your Email:
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Please check the box to continue.
I AM NOT A ROBOT.