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:
 
* Client Mailing Address Line 1:
   
* Client Last Name:
 
Client Mailing Address Line 2:
 
Client Social Security #: xxx-xx-xxxx
 
* Client City:
   
Client Phone Number: xxx-xxx-xxxx
 
* Client State:
Client Date of Birth: MM/DD/YYYY
   
* Client Zip:
 
 
* 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).


   
The following fields are REQUIRED when submitting this form online.

* Your First Name:

* Your Last Name:
   
* Your Phone: xxx-xxx-xxxx
 
* Your Email:
 
 

Please check the box to continue.