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Suspected Fraud Referral
Suspected Fraud Referral
"
*
" indicates required fields
Reported by:
*
Individual
Provider
Coalition/Contractor
Department of Early Learning
Anonymous
Name
First
Last
Email
Phone
Complaint Against
*
Individual
Provider
Coalition/Contractor
Department of Early Learning
Anonymous
Name/Company
First
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
Phone
Child Care ID#
Details of suspected fraud being committed:
*
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