BHDC Fraud / Compliance Report Form 2013

BHDC is committed to protecting the integrity of the federal and state programs it administers. If you have reason to believe that any fraudulent activity is taking place in connection with any of the programs that BHDC administers please report the matter promptly. Program violations may be committed by tenants or owners participating in housing programs, as well as employees of BHDC.

Items to consider while completing this form:  Please provide as much information as possible regarding the person(s) you are reporting and the nature of the violation. The more information that is reported, the better the chance there is of determining if fraudulent activity has taken place. Without, sufficient information, we will be unable to investigate the suspected activity.  The information you provide BHDC is strictly confidential. Due to federal regulations, BHDC cannot comment on actions taken after your allegation is reported. However, we assure you that all allegations will be reviewed to determine whether fraud is taking place and the appropriate penalties will be issued if fraudulent activity is proven. We encourage and appreciate your support in this matter.

Information concerning the fraudulent activity:

1. WHAT Provide details of the alleged fraud, waste, abuse or mismanagement. Examples of facts and circumstances to include are (1) a description of the misconduct; (2) how you know about the allegation; (3) how and when the misconduct was discovered; (4) the amount of money involved; (5) how long the alleged misconduct occurred; (6) attempts by the alleged violator(s) to hide the misconduct; and (7) any other information you believe may be relevant. Please use a separate page if needed.

2. WHEN When did the misconduct occur? If the misconduct occurred over time or is currently ongoing, enter the actual or approximate start date.

3. WHERE Where did the misconduct occur?

4. WHO Identify the primary person or entity who engaged in the alleged misconduct. If more than one person is involved, enter the additional identifying information below.

5. OTHER Please provide any additional information concerning this misconduct, such as (1) a list or description of any documents or other evidence you or others may have that is relevant to the complaint; (2) the names and contact information for other witnesses who could provide additional information; and (3) any other information you believe may be relevant to the complaint. (use additional pages as needed)

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D:\Docs\2018-04-13\0dd7af3f71d6c2f8af4c45018b10d096.doc Your information:

Using the following list, please choose your filing status:

 Confidentiality and Anonymity is not requested. If necessary, you may contact me for additional information and I do not place any restrictions on the release of my contact information. Please fill out the contact form below.

 I wish to remain Confidential: You may contact me for additional information, but please keep my name confidential and do not share it outside of the Office of the Inspector General. Our policy is to honor requests for confidentiality and not to release any data that would identify such individuals unless required to do so by order of law (e.g., court order/subpoena). Please fill out the contact form below.

 I wish to remain Anonymous: If you choose to remain anonymous, it is not necessary to fill out the contact information. It is important to note that we will not be able to contact you if we need additional information about your complaint.

If you selected either of the first two status options please complete the below information:

Name (first, last):

Mailing Address:

Primary Phone Number:

Signature:

For more information about fraud in subsidized housing:

The HUD Office of Inspector General is in charge of fraud for subsidized programs. The OIG makes sure rental assistance money is used properly. The OIG investigates complaints about tenants, landlords, or agencies that are not following the rules of the programs. They can be contacted by:  Phone - 1-800-347-3735  Email - [email protected]  Fax – 202-708-4829  Mail – HUD OIG Hotline (GFI), 451 7th Street, SW, Washington, DC 20410  Website: www.hud.gov

Fraud can also be reported to the MA Department of Housing and Community Development at 617-573-1100.

PLEASE RETURN THIS FORM TO: BHDC ATTN: Program Representative 1 Fenn Street, 3rd Floor Pittsfield, MA, 01201

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