Skip to Main Content
Loading
Loading
Government
Community
I Want To...
Home
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
Airport
Animal Services
Board of Commissioners
Building Inspections
Contact
County Manager's Office
COVID-19
Elections
Emergency Services
Environmental Management
Facilities Management
Finance
Health Department
Human Resources
Information Technology
Library
Parks & Recreation
Planning & Development
Purchasing
Register of Deeds
Rowan Transit System
Sheriff's Office
Social Services
Soil & Water Conservation
Tax Administration
Telecommunications
Veterans Services
Wellness
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Report Benefit Fraud
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
About the Report and Reporter
Reporter's Name
Remain Anonymous
Yes
No
May an investigator contact you for more information if necessary?
Yes
No
Phone Number
What is your relationship or connection with the client?
How long have you known the client?
About the Client
Client's Name
*
Client's Date of Birth/Age
Client's Address
County
Client's Phone Number
Does the client have a spouse or significant other (SO)?
Yes
No
Spouse/SO's Name
Spouse/SO's Date of Birth/Age
Spouse/SO's Address
County
Other Spousal/CO Information
Does the client have children?
Yes
No
Children's Name(s) and Ages
Other Information on Children
Is the client employed?
Yes
No
Employer
How long with this employer?
Other Employment Information
About the Fraud Allegations
What is the nature of the allegation?
*
Selling FNS benefits/trafficking
Misrepresenting household composition
Underreporting income/exaggerating expense
Living outside NC
Selling FNS benefits/trafficking
How long has this been occurring?
To whom is the client selling benefits?
Where is the sale taking place?
How do you know this information?
Misrepresenting household composition
How long has this been occurring?
Who is the client claiming/not claiming?
How do you know this information?
Underreporting income/exaggerating expense
How long has this been occurring?
What is the client reporting/not reporting?
How do you know this information?
Living outside NC
How long has this been occurring?
Where is the client living?
How do you know this information?
Is there anything else that you can thing of that might assist in the investigation?
Rowan County considers all reports of fraudulent activity important. Please contact us again if you have additional information.
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
* indicates a required field
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow