Department of Business and Professional Regulation (DBPR)
Office of Inspector General

Complaint Form



** Indicates mandatory fields

Complainant's Contact Information (You may remain anonymous if you choose. However, it will be more helpful if we have the
ability to contact you for additional information and/or clairification of the issues you are reporting. Not providing your name and
contact information may limit our ability to act upon your complaint.):

First Name:
Last Name:
Email Address:
Mailing Address:
City:
State:
Zip:
Personal Phone Number:
Division, if employee:
Work Address:
City:
State:
Zip:
Work Phone Number:

**Are you a:

Current employee of a state agency or a state agency's contractor?
Yes   No

Former employee of a state agency or a state agency's contractor?
Yes   No

Applicant for a position with a state agency or a state agency's contractor?
Yes   No

If one of the above is checked "Yes", which state agency or contractor?


**Have you reported this issue/allegation to any other person or office?
Yes   No

If yes, please indicate which person or office you contacted, when you contacted them, and what the results were.


**Information about the employee, individual, business, or organization that is the subject of this complaint:

First Name:
Last Name:
Position/Title:
Name of Business/Organization:
Address:
City:
State:
Zip:
Telephone Number:

Enter the division/bureau/area in which the subject is employed. If you are not sure of the correct location, enter "I don't know" in the space provided.

Division/Bureau/Area:
** What are you alleging occurred or is occurring?

When submitting a complaint, please be as specific as possible since this will allow us to assist you better. Describe in detail what the subject did that you believe was or is improper, prohibited, or in violation of agency rule or law (e.g., fraud, waste, abuse, misuse of position, state funds, state property, or state equipment, bribery, or falsification of records). Please indicate when this occurred, where it occurred, over what period of time it occurred, and how it occurred. Identify any potential witnesses who have information about the alleged violation(s). Also, identify any documentary, physical, video, or other evidence that is relevant to the alleged violation(s) and indicate where or how the OIG can obtain this evidence.


Upon receipt of your complaint, the OIG will review it to determine the appropriate action; you will be advised in writing of the outcome of this review. The OIG may request additional information from you before concluding its review.

Certification - By clicking "Submit", you certify that the information contained herein is true and correct to the best of your knowledge.


If mailing the Complaint Form, please send to the address shown and attach copies of any related documents. Office of Inspector General
2601 Blair Stone Road
Tallahassee, FL 32399-1018
850.414.6700
850.921.2683 (Fax)


** Indicates mandatory fields