Complaint Form

DIASTER AND STIMULUS FUND FRAUD, WASTE, OR ABUSE:
Following Hurricane Katrina, millions of dollars have been disbursed to individuals, government entities, non-profit entities, and other business entities in the coastal counties of Mississippi for assistance and relief. Additionally, millions of dollars in stimulus funds have been awarded to the above described funds and would like to report this information. Please complete the complaint form at our Web site or write the Disaster Fraud Prevention and Detection Unit at P.O. Box 16088, Hattiesburg, MS 39404-0688 or contact us by phone at 1-800-956-1846.

All information concerning the identity of a person or group of persons making a complaint is strictly confidential and will not be released by this office unless pursuant to an order by competent judicial authority. However, such information may be shared with other governmental agencies that become involved during the course of any related investigation.

Mississippi public employees are protected by the Whistleblower Act (M.C.A. 25-9-171 ET SEQ) from retaliation resulting directly from truthfully testifying or providing information of improper governmental action.

Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers may not respond properly. If you experience any difficulties, you may email: Auditor@osa.state.ms.us or call 1-800-321-1275.

* Indicates a required field.

I. PERSON MAKING COMPLAINT (COMPLAINANT)
*Name:
*Address:
*City:		*State:	*Zip:
Phone:	Home:	Office:
*Email:

II. PERSON(S) AGAINST WHOM COMPLAINT IS MADE (SUBJECT)

*Name:
Address:
*City:		*State:	*Zip:
Phone:	Home:	Office:
*Title:

III. DID YOU OBSERVE THE VIOLATIONS?

Yes

If so, are you willing to sign a sworn statement about the violations?

Yes

Not Applicable

IV. ALLEGATIONS AND STATEMENTS OF FACTS?

* In your own words, please describe the violations of law which you have observed. The description should include the alleged violation and any details relating to it, such as names, additional witnesses, dates, places, and amount of money, if known. (enter a maximum of 2048 characters in 32 lines of text)

V. I do certify that the statements mentioned in the above complaint are true and correct to the best of my knowledge and are made of my own free will. I understand that false reporting of a crime (97-35-47) or any element of a crime to any law enforcement officer or to any officer of any court is a crime punishable by one year imprisonment and payment to the law enforcement agency or court of all costs and expenses involved in the investigation of the false crime. This law is strictly enforced.