Child Care Client Provider Reporting Form
Note: Fields with * must be completed
Reporter’s Contact Information
Providing your contact information is not required, but helpful in the event additional information is needed from you as the reporter.
Your contact information will remain confidential and not shared with anyone.
To remain anonymous, please do not complete this section.
Client Fraud Information
Please provide any known information as it relates to your concern about possible child care fraud.
This information is necessary in order to adequately investigate your allegation.
How did you learn about the suspected fraud?
*Explain in as much detail the nature of the alleged child care fraud: