Suspected Fraud/criminal Activity Complaint Form printable pdf download

Suspected Fraud/Criminal Activity Complaint Form

Policy Statement

The Rockford Housing Authority is dedicated to providing quality, affordable housing opportunities and to

improve the lives of our clients. We encourage self-sufficiency and we protect the dignity of people with

limited resources while safeguarding public trust. The Rockford Housing Authority vigorously pursues fraud

and criminal activity allegations and strongly encourages those with information regarding fraud/criminal

activity pertaining to applicants,tenants, or landlords to notify the Rockford Housing Authority by

completing this form or by calling the hotline at

815-489-8549.

PLEASE PRINT INFORMATION LEGILBLY

DATE________________________NAME OF SUBJECT__________________________________________

ADDRESS OF SUBJECT:___________________________________________________________________

YOUR NAME____________________________YOUR TELEPHONE NUMBER________________________

WOULD YOU BE WILLING TO TESTIFY AT AN INFORMAL ADMININSTRATIVE HEARING? [] YES [] NO

Narrative – Who and what are you alleging?

[] Applicant

[] Tenant

[] Landlord

_______________________________________________________________________________________________________

________________________________________________________________________________________________

If the complaint is regarding unauthorized people living in the unit, please complete the following, if known:

Names of unauthorized residents.

Adults: ________________________________________________

Minors: ________________________________________________

Is the unauthorized resident employed or receiving other income? [] YES [] NO IF yes, where or what source

of income?

__________________________________________________________________________________________

Does the unauthorized resident own a vehicle(s)? List license plate number(s): __________________________

Does the unauthorized resident receive mail at the address? [] YES [] NO [] UNKNOWN

Suspected Fraud/criminal Activity Complaint Form