DSS Fraud Reporting Form

Report Fraud Committed by a Department of Social Services Client, Provider or Vendor in Broome County, NY. If you are not reporting a fraud committed in Broome County, NY or by a Broome County Resident, Provider or Vendor, please contact your local Department of Social Services.

Use this form to report a client that you believe has fraudulently received assistance from programs administered by the Broome County Department of Social Services. This includes but is not limited to Temporary Family Assistance, Food Stamps, HEAP, Medical Assistance and Daycare.

Examples of situations that are fraudulent are: unreported income (either earned or unearned), hidden assets (bank accounts, property, etc.), unreported changes in household composition (either someone moved into the home or moved out), changes in shelter cost, etc.

If you want to report fraud committed by a provider or vendor you should do so by also completing this form.

If you suspect or have knowledge of fraud fill in the form below. You may then submit the form electronically.

Your name and phone number are optional but would be helpful to us in case we need to contact you for additional or clarifying information.

Your Personal Information
Client/Provider/Vendor Information

Please enter ALL the information you have regarding the allegation or suspicion of how the client(s) is defrauding the department.

Note: Because of confidentiality laws we are NOT able to inform or respond to you as to the outcome or specifics of a case.

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