Intake Form

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Please correct the fields below:

Please correct the field(s) marked in red below:

1

What government departments/ agencies are involved?

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What government departments/ agencies are involved?

2

Describe the possible fraud, waste or abuse.

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Describe the possible fraud, waste or abuse.

3

Who are the people involved? If a government employee is doing something wrong, in which government agency does the person work? Are there other witnesses with whom we should speak?

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Who are the people involved? If a government employee is doing something wrong, in which government agency does the person work? Are there other witnesses with whom we should speak?

4

What is the approximate date or dates of these incidents?

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What is the approximate date or dates of these incidents?

5

Please provide any other details that may help us research these matters.

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Please provide any other details that may help us research these matters.

(Optional) Please provide your name, an e-mail address, and/or a phone number where we can contact you for more information. Your identity will remain confidential. You do not have to provide this information, but it helps us to have an initial contact when we begin our research.

6

Name

7

Email Address

8

Phone Number

9

Please attach any documents or other files that you have. You can also e-mail these documents to concern@hawaiicounty.gov. (Optional)

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