Anti-Fraud, Waste and Abuse Allegation Report

Name: Emergent Method
Price range: $

Thank you for helping fight fraud, waste and abuse in the Restore Louisiana Homeowner Assistance Program.

Please describe the incident you are reporting. It is vital to include as much detail as possible.

Name of the person who allegedly performed the suspect activity?

Please provide a way we can locate this person (address, phone, etc.)

When did the suspected activity occur?

Have you reported this allegation to another entity for investigation?

Yes

Where was it reported?

When was it reported?

Do you have any evidence to support this allegation?

Yes

Please describe the evidence.

Please upload or mail us copies of any supporting documents.

If uploading, you can submit up to 3 files (15 MB max for each).

If mailing, please send copies to:

AFWA Manager
10000 Celtic Drive
Oak Tree Building
Baton Rouge, Louisiana 70809

Contact Information (optional)

Although you may remain anonymous, providing us with your contact information may be VITAL to our successful investigation.

Your name, contact information, and your allegation will be kept confidential.

Restore Louisiana Account #

First Name

Last Name

Phone

Confirm Email

Date Completed