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Complaints of Fraud, Waste, Abuse, or Mismanagement

The purpose of this survey is to receive complaints of fraud, waste, or abuse in our agency program and operations, including mismanagement of funds or violations of law, rules, or regulations by employees.

For telephone reporting, call 816-257-9312. Complaints may also be emailed to tfrancis@hopehouse.net.

Hope House prohibits retaliation against any person who in good faith reports an ethics violation or a suspected violation of law.

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* 1. Please select one of the following options:

I am providing my name and I agree that Hope House can disclose my name and other information I provide, if necessary, in order to ensure my issues are addressed.

I wish to be confidential, meaning I am providing my name, but I request that Hope House not disclose my name outside the agency. (this category is appropriate for complainants who fear reprisal from wrongdoers for contacting Hope House.)

I wish to be anonymous, meaning I have not provided my name. I understand that if I make this selection, Hope House will not be able to contact me and I understand that Hope House may not have enough information to pursue my concern and I may not be able to find out results of any investigation conducted.

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* 2. Name

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* 3. Mailing Address

Address 1

Address 2

City State Zip

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* 4. Phone Number

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* 5. Email Address

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* 6. The alleged violator or subject (enter all available information):

Name (if known)

Title (if known)

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* 7. What would you like to report?

Contract, Grant, or Procurement Fraud

Bribery/Conflict of Interest

Employee Misconduct

False Claims

False Statements

Mismanagement

Computer Crime

Travel/Time and Attendance Fraud

TheftEmbezzlement

Other (please specify)

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* 8. What is the problem you want to report? Describe the problem as specifically as possible. Please explain how your allegation relates to fraud, waste, or abuse. Please provide a description of the facts and circumstances surrounding the reported activities, including the evidence forming the basis of this report.

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* 9. When and how did you become aware of the problem? Please identify potential witnesses and their involvement and any corrective action taken by you, the company, or any other entity.

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* 10. How long has the problem existed?

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* 11. When was the most recent occurrence of this problem?

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* 12. If known, please provide award/contract information. Please include the award number/contract number, period of performance (dates of award), award value, and disbursement amount.

Complaints of Fraud, Waste, Abuse, or Mismanagement

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* 1. Please select one of the following options:

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* 2. Name

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* 3. Mailing Address

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* 4. Phone Number

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* 5. Email Address

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* 6. The alleged violator or subject (enter all available information):

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* 7. What would you like to report?

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* 9. When and how did you become aware of the problem? Please identify potential witnesses and their involvement and any corrective action taken by you, the company, or any other entity.

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* 10. How long has the problem existed?

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* 11. When was the most recent occurrence of this problem?

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* 12. If known, please provide award/contract information. Please include the award number/contract number, period of performance (dates of award), award value, and disbursement amount.

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* 13. Is there any additional information that might be useful to us in evaluating this complaint?