Nevada DETR Web File Transfer Client - Forms -DETR Unemployment Insurance Fraud Reporting Form

DETR Unemployment Insurance Fraud Reporting Form

Please provide all known information regarding suspected fraud, as accurate and thorough information will help facilitate an efficient investigation. Fields marked with an asterisk (*) are required.

Your identity will be kept confidential. We cannot provide information on the results of any investigation. Your information is appreciated.

Employee/Complaint Information

Please provide us your contact information. (All information is kept strictly confidential).

First Name*

Last Name*

Telephone Number

Email Address*

Physical Street Address

Apt/Space No

City

State

Zip Code

Currently Employed

Most recent employer

Additional Information

Please describe what leads you to believe fraud has been committed.

Was there payment made and if so, how were you made aware of payment?

Discovered through:

Communication received direct by:

Employee

Employer

Benefit card received by employee

Direct deposit received by employee

Employee provided false information to obtain benefits

Other means (please describe)

Additional Reporting Issue(s)

Please select the type(s) of issue(s) you wish to report. You may select more than one.

No claim was filed by employee or authorized third party

Individual passed away yet someone continues to file and collect benefits

Individual is incarcerated in a county, state, or federal facility or is on work release

Individual was offered employment and refused or refused to work all hours offered by employer

Individual is working either on the books or under the table for cash while collecting unemployment

Other - must provide written details (may include not seeking employment)

Additional Documentation

File Types Allowed (.doc, .docx, .docm, xls, .xlsx, .txt, .pdf, .rtf, .snp, .msg, .tif, .tiff)

Files (Max Size 100MB)

Drop files here, or browse to attach files

Confirmation Required

Are you sure you want to remove the selected file?

Please add any additional information you would like to provide

Due to strict confidentiality laws, the Nevada Department of Employment, Training, and Rehabilitation cannot confirm or deny an investigation initiated by the submission of this form nor can updates or outcomes be disclosed. We will review the necessary files and records in light of the information you have provided to determine the most appropriate action. If you provided information about yourself, you will be contacted again only if it is necessary to complete our investigation. Thank you for assisting in our effort to fight fraud, waste and abuse.

Penalty of Law Notice

By submitting this report, I certify that all information provided is true to the best of my knowledge. I understand that filing a false report is a fraudulent act and may be subject to civil and criminal action.