Report someone receiving UI benefits but not reporting that they are being paid in cash for working on the side.
Name of person receiving unemployment benefits:
Last 4 digits of their SSN:
Their date of Birth (mm-dd-yyyy):
Their Telephone number:
Where they are working?
When did he/she start working?
Is he/she working full-time or part-time?
What kind of work is he/she doing?
Does he/she own a business?
Name of their business:
Is the business operated out of their home?
Provide a brief description of your concerns:
Please enter your contact information in case we need to contact you.
This is optional
and will be kept confidential.
Enter your name (
Enter your phone number
Enter your e-mail address (
Enter your street address (