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Minnesota Unemployment Benefits Fraud Report

Minnesota Unemployment Benefits Fraud Report

Minnesota Unemployment Benefits Fraud Report

A. Contact Information
Note: The benefits of having a witness can be crucial to effective enforcement. This information would enable an investigator to contact you for additional information (if needed) to help with additional fact-finding.
Your Name:
Your Telephone Number: Call me to discuss this
Your Email Address:
B. Information about UI Benefit Recipient
Please supply as much information as you can to the following questions:
1. Full name of the person suspected of committing fraud:
2. Social Security Number, if known:
3. The person's address:
   City, State & ZIP:
4. The person's phone number:
5. Do you have evidence or knowledge that the individual you are reporting is or was involved in possible unemployment benefit fraud?

Be as specific and thorough as possible:

6. Name of business or employer the person is or was working for:
7. Employer's address:
   City, State & ZIP:

8. How is or was this person being paid? Cash   Check   Barter   Other*
* If Other please explain:
9. To what business or individual name are the checks payable?
10. If payment is or was cash, who is or was paying the cash and where is the record of cash disbursement kept?
11. When did the person begin work: Mo: Day: Yr:
 
12. What days and hours does or did this person work?:
13. What type of work does or did the person do?:
14. If the person is or was in jail, on vacation or unable to work due to illness or injury, please give as much information as possible:


15. If the person has started their own business, please provide as much of the following information as possible:
  • type of business,
  • name, address, and phone number of the business,
  • advertising information (business cards, newspaper ads, flyers, posters, etc.),
  • name(s) of customer(s) who used this business and their address(es) and phone number(s),
  • and, any other information we may use to prove the business exists.


 

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