Tax Fraud Form

UC – Fraud Reporting System

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Tax Fraud Form

Please use this form to report employers committing fraud against the Pennsylvania Unemployment Compensation program.

Contact Information
Please provide your contact information.
First Name		Last Name
Phone		Email
Would you prefer to remain anonymous?		YesNo
Note: This information will remain confidential. You will only be contacted if additional information is needed.

Employer Information

Please supply as much of the following information as you can.

Employer Name

Employer Account Number

Address1

Address2

City

State

ZIP

Phone

Explain in detail what the employer is doing to circumvent the unemployment system.

How many employees are affected?

Affected employee(s) name(s)

First Name		Middle Initial
Last Name		SSN
Phone
First Name		Middle Initial
Last Name		SSN
Phone

First Name		Middle Initial
Last Name		SSN
Phone
First Name		Middle Initial
Last Name		SSN
Phone

Please enter worksite address, if different than Employer's address.

Worksite Address1

Address2

City

State

ZIP

Phone

Type of Work

Method of Payment

CashCheckBarterUnknown

We will review the necessary files and records in light of the information you have provided to determine the most appropriate action. If you provided contact information, you will be contacted again only if it is necessary to complete our investigation.

Due to strict confidentiality laws, the Department of Labor and Industry cannot confirm or deny an investigation initiated by the submission of this form nor can updates or outcomes be disclosed.

Thank you for assisting us in our efforts to fight fraud, waste and abuse.

Fraud Forms