DIVISION OF UNEMPLOYMENT INSURANCE
Benefit Payment Control
1100 North Eutaw Street, Room 206
Baltimore, MD 21201
UI.Fraud @maryland.gov | 410-767-2404 | Fax: 410-767-2610 | www.labor.maryland.gov
LARRY HOGAN, GOVERNOR | BOYD K. RUTHERFORD, LT. GOVERNOR | TIFFANY P. ROBINSON, SECRETARY
REQUEST FOR INVESTIGATION OF UNEMPLOYMENT INSURANCE FRAUD
Mail to: Benefit Payment Control, Room 206, 1100 North Eutaw Street, Baltimore, MD 21201 or Fax to 410-767-2610
Person receiving Unemployment Benefits
Social Security Number (if known)
This person is: (check all that apply and complete)
Phone
Employed and Filing for Unemployment Benefits
Name of Business
Address
First
day of work (approximate)
Self-Employed
Name of Company
Phone
Address
Website
address When did he/she start working?
Incarcerated / Jail
Name of Institution
Date of Incarceration
Not Able and Available for Work
Reason (i.e. illness, etc.)
Date
of restriction
Out of state or country
Where (location/address)
Reason: Working
Vacation / Personal Business
Dates
In School
Where
Dates of Attendance
Other
Please provide any additional information available:
Your Name:
Phone
What is your relationship with the person receiving unemployment insurance?
I wish to remain anonymous Yes No
(Note: You may remain anonymous, but it is important that the investigator is able to contact you for additional information.)
