Fraud, Waste, and Abuse Reporting Form

For more information about reporting fraud, waste and abuse, please visit the "Fraud, waste, and abuse" section.

Institution Involved *

In your own words, please describe the who, what, when, where and how of the fraud, waste or abuse *

Name(s), job title(s), department(s) of the individual(s) involved

Date of occurrence

Month

Day

Year

Time of occurrence

Hour

Minute

Describe how and when you became aware of the problem being reported

If you have reported your concern to any other department, school or agency, to whom did you report your concern

If you wish to remain anonymous, you do not have to provide contact information. We encourage you to provide your contact information for any follow-up questions that may arise during our review or to obtain a copy of the final report at the completion of the review. All contact information provided is considered confidential under TCA 8-50-116. However, if TBR or one of its institutions has a separate legal obligation to investigate the complaint (e.g., complaints of illegal harassment or discrimination), TBR and its institutions cannot guarantee anonymity or complete confidentiality.

Your First Name

Your Last Name

Your Work Phone Number

Alternate Phone Number

Email Address

If there are other individuals aware of this problem who could provide more information, provide their full names and contact information

Do you have documents to attach?

Attachments

Attachment

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx ppt pptx xls xlsx.

Attachment 2

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx ppt pptx xls xlsx.

Attachment 3

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx ppt pptx xls xlsx.

Attachment 4

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx ppt pptx xls xlsx.

Attachment 5

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx ppt pptx xls xlsx.

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Fraud, Waste, and Abuse Reporting Form