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Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives



211 - Get Connected. Get Answers.

WIC Participant Fraud Reporting Form

Name of WIC Participant:

(First Name)

(Last Name)
WIC Participant ID:

(if available)
WIC Participant’s Gender:
Male
Female
List all WIC Participants in the Family:

(Please list names and WIC participant ID Numbers (if available))
WIC Participant Address:

(if available)
City:
State:
Zip Code:
WIC Participant Telephone Number:

(Please enter the phone number in XXX-XXX-XXXX format.)
In the box below, please provide a description of the suspected WIC participant fraud. Be sure to include the important details such as names of persons involved and dates if available.
Suspected Fraud Details:
You are able to report suspected WIC Participant fraud anonymously, but if you would like the WIC State Agency to contact you, please complete the fields below:
Name:
Telephone Number:
E-Mail Address: