File a Complaint File a Complaint Order Number NOTE: Completion and submission of this form will result in a whistleblower complaint report being emailed to our Whistleblower Unit. Once received by our office, the information provided below will be handled under confidentiality requirements established by the state’s Whistleblower Act. What type(s) of fraud, waste, or abuse are you reporting? (check all that apply:) Theft or Misuse of State Resources Purchasing or Procurement Corruption (Bribery/Kickback) Contract or Grant Management Financial Statement Public Assistance Work Injury Unemployment Health Care Waste: (Intentional or unintentional, thoughtless, or careless expenditure, consumption, mismanagement, use or squandering of State resources. Waste includes incurring unnecessary costs because of inefficient or ineffective practice, systems or controls.) Abuse: (Government Auditing Standards defines abuse as behavior that is deficient or improper when compared with behavior that a prudent person would consider reasonable and necessary business practice given the facts and circumstances. Abuse also includes misuse of authority or position for personal financial interests or those of an immediate or close family member or business associate.) Other Name of Agency or Large State Contractor involved in waste, abuse or fraud: Not Listed African American Affairs Asian Pacific American Affairs BEST Bureau Ent Srvcs Tech Board for ST Academic Awards Board for State University Board of Firearms Perm Examnrs Board of Pardons Board of Parole Board of Regents for Higher Ed BOT System Office Bradley Enterprise Fund Brd of Ed & Serv for the Blind Bureau of Rehabilitative Serv Capital Region Development Aut Capitol Preserv & Restoration Central CT State University Child Protection Commission Claims Commissionr, Off of the Clean Energy Fin & Invest Auth Comm on Human Rghts & Opportun Comm. On Culture and Tourism Commiss Deaf & Hearing Impaird Commission on Aging Commission on Children Connecticut State Library Connecticut State University Council Adm Childrens Trst Fd Council on Environmental Qual Criminal Justice Commission CT Agricultural Experimnt Stat CT Airport Authority CT Community Colleges CT Development Authority CT Housing Finance Authority CT Innovations Inc CT Lottery Corporation CT Port Authority CT Siting Council DCS Construction Services Department of Agriculture Department of Banking Department of Construction Se Department of Correction Department of Education Department of Higher Education Department of Housing Department of Insurance Department of Labor Department of Motor Vehicles Department of Public Health Department of Public Safety Department of Public Works Department of Revenue Services Department of Social Services Department of Transportation Department of Veterans Affairs Dept of Administrative Servcs Dept of Children and Families Dept of Consumer Protection Dept Of Developmental Services Dept of Economic & Cmmunty Dev Dept of Environmental Protectn Dept of Public Utility Control Division of Criminal Justice Division of Special Revenue Eastern CT State University Elections Enforcemt Commission Emergency & Homeland Security Ethics Commission Fire Prevention & Control Freedom of Info Commission Gaming Policy Board Governors Office Historical Commission Judicial Branch Judicial Review Council Judicial Selection Commission Latino/Puerto Rican Affair Com Legislative Management Lieutenant Governors Office Mental Health & Addiction Svcs Military Department Off of the Chief Med Examiner Off of Wrkfrce Competitiveness Office of Child Advocate Office of Consumer Counsel Office of Early Childhood Office of Policy & Management Office of the Attorney General Office of the Comptroller Office of the Healthcare Advocate Office of the State Treasurer Office of Victim Advocate Perm Comm on Status of Women Police Officr Stds & Trg Counc Probate Court Administration Prot & Adv for Pers w/Disabils Psych Security Review Board Public Defender Services Secretary of the State SMART Small Agy Res Team Soldier Sailor & Marine Fund Southern CT State University Special Education ST Insurance & Risk Mgmt Board State Contracting Standards Bo State Department on Aging State Dept of Rehabilitation State Marshal Commission State Properties Review Board Teachers Retirement Board Tweed New Haven Airport Authority UConn Health Center University of Connecticut Web Design / Graphics Western CT State University Workers Comp Commission Connecticut Community Colleges Address of Agency or Large State Contractor where this issue occurred (if available): Name of Person involved in waste, abuse or fraud What is your involvement in the issue? It happened to me I was involved I observed it I overheard it Someone told me about it Other What are the allegations? Do you have any documentation or evidence to provide that supports your allegations? Do you have any files to attach? Yes No Is this an ongoing issue? Yes No I don't know What is the date of the most recent occurrence? Have you reported this to anyone within the State of Connecticut? Yes No How many other people are involved in the issue other than yourself? The APA accepts complaints that are submitted anonymously; however, if the complainant is unavailable to answer questions or confirm the alleged facts, our office may be unable to proceed with an investigation. File Anonymously * Yes No Name: * Contact Number: * E-Mail: Address: NOTE: The APA shall not, after receipt of any information from a person under the provisions of the Whistleblower Act, disclose the identity of such person without consent unless the APA determines that such disclosure is unavoidable during the course of the review. You can also file a complaint with the Auditors of Public Accounts by calling (860) 240-5369, toll free at (800) 797-1702, by email at firstname.lastname@example.org or by sending the information in writing to : Auditors of Public Accounts 165 Capitol Avenue Hartford, CT 06106-1659 Attention: Maura Pardo, Administrative Auditor The APA shall not, after receipt of any information from a person under the provisions of the Whistleblower Act, disclose the identity of such person without consent unless the APA determines that such disclosure is unavoidable during the course of the review. If you have any files you would like to send in association with your complaint, please email them to email@example.com.