Homeowner Assistance Program Anti-Fraud, Waste and Abuse Allegation Report

What type of fraud, waste, or abuse are you reporting?

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?

How did you learn about the incident you are reporting to us?

Have you reported this allegation to another entity for investigation?

Where was it reported?

When was it reported?

Do you have any evidence to support this allegation?

Please describe the evidence.

Please upload or mail us copies of any supporting documents.

File Upload

If mailing, please send copies to:
AFWA Manager
10000 Celtic Drive
Oak Tree Building
Baton Rouge, Louisiana 70809

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 #

Name

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Last

Phone

E-mail

Email

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Date Completed