Complaint Form

Fraud, Waste, and Abuse Reporting Form

The Arkansas Whistle-Blower Act prohibits a public employer from taking adverse action against a public employee who communicates in good faith to an appropriate authority the existence of waste of public funds, property, or manpower or a violation of law; participates, or gives information, in an investigation, hearing, court proceeding, legislative inquiry, or administrative review; or objects to carrying out a directive the public employee reasonably believes violates the law. For more information consult Ark. Code Ann. §§ 21-1-601 to 21-1-610.

Complainant Information (Optional)

This office accepts anonymous complaints when requested; however, additional informational may be needed for clarification. Although it is not a requirement when submitting a complaint, we ask that you provide a way to contact you.

Are you reporting anonymously?(Required)

Yes

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Employment Information

Are you an employee of a state agency, department, board, or commission?(Required)

Yes

List the name of the state agency, department, board, or commission of which you are employed.

Complaint Details

PLEASE DO NOT PROVIDE ANY DATES OF BIRTH, SOCIAL SECURITY NUMBERS, DRIVER’S LICENSES, MEDICAL RECORDS, CREDIT CARD INFORMATION, OR PASSPORT INFORMATION

Name of the state agency, department, board, or commission involved.

State Employee(s) or Individual(s) involved.

Position Title of Employee(s) or Individual(s) involved.

Details of Complaint

Details of facts relevant to the allegation. Please provide as much detail as possible including who, what, when, where, why and how.

Relevant Documentation

Drop files here or

Max. file size: 50 MB.

Please provide any relevant documents regarding this allegation with this complaint form. If there are relevant documents that you do not have access to, please describe those documents and how they can be obtained by Internal Audit.

Has this complaint been filed with any other agency?(Required)

Yes

Unknown

What Agency?

Is there any civil, criminal, or administrative proceeding pending in this matter?(Required)

Yes

Unknown

Please Explain.

In case of referral to another agency, should your name and contact information be removed?(Required)

Yes

Other

Please explain.

Internal Audit

Fraud, Waste, and Abuse Reporting

Fraud, Waste, and Abuse Reporting Form

Complainant Information (Optional)

Employment Information

Complaint Details

Your Arkansas.gov

Top Online Services

Helpful Information

Internal Audit

Complaint Form

Fraud, Waste, and Abuse Reporting

Fraud, Waste, and Abuse Reporting Form

Complainant Information (Optional)

Employment Information

Complaint Details

Your Arkansas.gov

Top Online Services

Helpful Information

Flag Status