Fraud - CDBG-DR Public

1. Do you wish to remain anonymous?*

Yes

No

If your answer is “YES”, it is not necessary to complete the contact information section. In that case, bear in mind that PRDOH will not be able to contact you in case of needing additional information regarding your complaint.

2. Do you wish to maintain your contact information private? *

Yes

No

If your answer is “YES”, your contact information will not be shared outside the Internal Audit Office of CDBG-DR.

A- CONTACT INFORMATION

Email Address

Name

Middle Name

Both Last Names

Address

State

Municipality/Town

Zip Code

Primary Phone

Secondary Phone

B- ALLEGATION DESCRIPTION

1. Are you a victim of the alleged fraud, waste, abuse, or mismanagement? *

Yes

No

2. Do you have evidence to support the allegations? *

Yes

No

3. Will you be able to provide supporting documents?*

Yes

No

4. Please provide information about your relationship with the person/entity who allegedly has committed or is involved in the fraud, waste, abuse, or mismanagement. *

5. Please provide a summary of the facts of the alleged fraud, waste, abuse, or mismanagement:*

i. Where did the fraud, waste, abuse, or mismanagement occur? *

ii. In what date (specific or range of dates) did the fraud, waste, abuse, or mismanagement happen?*

iii. Describe what happened. Please include specific details as to who was involved, and how did you obtain the information. Failure to provide sufficient information or documentation may prevent or delay the investigation of your complaint. *

DISCLAIMER

By submitting this form, you attest that all of the statements made, including any additional pages and/or supporting documentation, are true, complete, and correct to the best of your knowledge. In addition, you recognize that knowingly and willfully making a deliberate or materially false, fictitious, or fraudulent statement or representation in this AFWAM Submission Form is a criminal offense for which you may be prosecuted.

In accordance with 2 C.F.R. § 200.303, regarding internal controls of a non-Federal entity, PRDOH is committed to protect all Personally Identifiable Information obtained. This includes, but is not limited to, Social Security Numbers, driver’s license numbers, alien registration numbers, financial or medical records, biometrics or criminal history. Although PRDOH maintains a website with acceptable and reasonable precautions to protect your personal information, since no method of transmission over the Internet or storage of data on an Internet server is 100% secure, we do not guarantee its absolute security.

In the alternative, you may visit the Deputy Audit Director of CDBG-DR’s Internal Audit Office at PRDOH Headquarters, located in Barbosa Ave. #606, Juan C. Cordero Dávila Bldg., Río Piedras; or by email at hotlineCDBG@vivienda.pr.gov; or by postal mail to PO BOX 21355, San Juan, PR 00928-1355, addressed to the Deputy Audit Director for CDBG-DR Internal Audit Office. All complaints and supporting documentation received in the CDBG-DR Internal Audit Office are confidential.

PRDOH Hotline is always available at 787-274-2135 (English/Spanish/TTY).

Contact Information

Form

Additionally, you can contact:

CDBG-DR Anti-fraud, Waste, Abuse, or Mismanagement Policy