Your Contact Information First Name Last Name Email Phone Home Mailing Address Address Line 1 Address Line 2 City/Town State/Province -- Select --AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPalauPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon ZIP/Postal Code Are you a… Current Employee of a State Agency or a State Agency's contractor? Former Employee of a State Agency or a State Agency's contractor? Applicant for a position with a State Agency or a State Agency's contractor? None of the above.If one of the above, which Agency? -- Select --Division of Administrative Hearings (DOAH)Agency for Health Care Administration (AHCA)Department of Agriculture and Consumer Services (DACS)Department of Business and Professional Regulation (DBPR)*Department of Citrus (Citrus)Florida Department of Corrections (FDC)Department of Children and Families (DCF)*Department of Commerce (DOC)* (Formerly DEO)Department of Education (DOE)Department of Elder Affairs (DOEA)Department of Environmental Protection (DEP)*Department of Financial Services - CFO (DFS)*Office of Financial Regulation (OFR)*Office of Insurance Regulation (OIR)*Florida Guardian Ad Litem Program (GAL)Florida State University Office of Audit and Advisory ServicesDepartment of Health (DOH)Florida Highway Safety and Motor Vehicles (FLHSMV)*Justice Administrative Commission (JAC)Department of Juvenile Justice (DJJ)Florida Department of Law Enforcement (FDLE)Office of Attorney General (OAG)Department of Lottery (DOL)Department of Military Affairs (DMA)Department of Management Services (DMS)Office of Internal Audit University of Florida (UF)*Office of the Governor (EOG)Florida Commission on Offender Review (COR)Agency for Persons with Disabilities (APD)*Public Service Commission (PSC)Department of Revenue (DOR)Department of State (DOS)Florida CourtsFlorida Department of Transportation (FDOT)*Department of Veterans'Affairs (DVA)Board of Governors (BOG)Citizens Property Insurance Corporation (CPIC)Division of Emergency Management (DEM)Florida Housing Finance Corporation (FHFC)Florida Fish and Wildlife Conservation Commission (FWC)Florida Gaming Control Commission (FGCC)Office of Criminal Conflict and Civil Regional Counsel (OCCRC)Capital Collateral Regional Counsels (CCRC)None of the Above* Indicates that this agency's Office of Inspector General will accept this Whistle-blow Complaint directly. Provide details for the individual you are filing this complaint against. Do not enter your own information. First Name Last Name Position Title Phone Address of the subject of complaint Address Line 1 Address Line 2 City/Town State/Province -- Select --AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPalauPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon ZIP/Postal Code When did the alleged violation or suspected violation occur? (mm/dd/yyyy) Select the Office, Circuit/Region and County in which the person(s) are employed. If you are not sure of the correct location, select " I Don't Know" or "County Unknown" from the list. Office/Program -- Select --I Don't KnowAdult ServicesChild CareDevelopmental DisabilitiesDomestic ViolenceEconomic Self-SufficiencyFamily SafetyFinancial ManagementHomelessness ProgramGeneral ServicesInformation SystemsInspector GeneralMental HealthRefugee ServicesSubstance Abuse Circuit/Region -- Select --I Don't KnowCircuit 1Circuit 2Circuit 3Circuit 4Circuit 5Circuit 6Circuit 7Circuit 8Circuit 9Circuit 10Circuit 11Circuit 12Circuit 13Circuit 14Circuit 15Circuit 16Circuit 17Circuit 18Circuit 19Circuit 20HeadquartersNortheastNorthwestCentralSuncoastSouthernSoutheast County -- Select --County UnknownAlachuaBakerBayBradfordBrevardBrowardCalhounCharlotteCitrusClayCollierColumbiaDeSotoDixieDuvalEscambiaFlaglerFranklinGadsdenGilchristGladesGulfHamiltonHardeeHendryHernandoHighlandsHillsboroughHolmesIndian RiverJacksonJeffersonLafayetteLakeLeeLeonLevyLibertyMadisonManateeMarionMartinMiami-DadeMonroeNassauOkaloosaOkeechobeeOrangeOsceolaPalm BeachPascoPinellasPolkPutnamSt. JohnsSt. LucieSanta RosaSarasotaSeminoleSumterSuwanneeTaylorUnionVolusiaWakullaWaltonWashington Complaint Details - Provide as much information as you can Have you reported the alleged incident to any of the below or are you reporting this now for the first time? A supervisory official in writing The Chief Inspector General in the Executive Office of the Governor The Chief Inspector General's staff via the Whistle-blower's Hotline An Agency Inspector General or staff member (orally or in writing) The Florida Commission on Human Relations (orally or in writing) Reporting this now for the first time Suspected Violation (select all that apply) Falsified official records Created false or fictitious client files Wrongful use of position, employees, or equipment for personal gain Wrongdoing by management Retaliation against an employee Revealed confidential information Improper use of public money Contract fraud Did not follow laws, rules or policies when making a contract or purchase In contracts or making purchases the employee takes bribes, makes illegal bids, receives awards or fails to monitor a contract, has a conflict of interest or disobeys a rule Other… When submitting a complaint, please be as specific as possible. Give the name(s) of the DCF employee(s) or service provider who committed a wrongdoing such as falsification of records, fraud, waste, or mismanagement of State personnel, equipment, or monies. State exactly what happened. Provide witness' names and how to contact the individual(s), if known. Do you know the location of any records or documents to support your complaint? If so, please provide details of what they are and where they are located. Complaint Details Your complaint will be reviewed and assessed upon receipt and someone in either the Agency Office of Inspector General or the Office of the Chief Inspector General will advise you in writing of whether your complaint meets statutory requirements to be designated as a whistle-blower complaint. A determination will also be made whether the complaint warrants investigation by the Inspector General, or whether a referral to another entity (such an management) is more appropriate. The more specific information that you provide, the better we are able to assist you. By selecting "Yes" I am acknowledging that my complaint and any other preliminary information available alleging a possible prohibited or retaliatory personnel action against me may be forwarded to the Florida Commission on Human Relations, without redaction, pursuant to Section 112.31895(1)(b), Florida Statutes. Selecting "No" may prevent the Office of the Chief Inspector General from forwarding my complaint and any other preliminary information alleging possible workplace retaliation against me to the Florida Commission on Human Relations for investigative purposes Do you acknowledge the above statement? Yes, I acknowledge No Please select who you would like to send this information to: My agency's Office of Inspector General Office of the Chief Inspector General Submit