Section 1 of 1 in this document
Fraud Incident Report
Date of Incident
*
Time of Incident
*
Incident Type
CDL Testing
DL/ID
Team Member
*
Location of Incident (include county #)
*
CustFN
*
CustMN
CustLN
*
Address
*
Driver License Number
*
Date of Birth
*
SSN
*
ID Type Applied For
*
False Name Used?
Yes
No
False First Name Used
False Middle Name Used
False Last Name Used
*
False License Number
*
False Social Security #
*
False Date of Birth
*
False Address Used?
Yes
No
SPEX/State(s)
Notice Given
Yes
No
Investigator Notified
Yes
No
Central Programs Bureau Notified
Yes
No
Documents Presented
Birth Certificate
Not provided
Valid
Altered
Counterfeit
Upload File(s): Birth Certificate
Social Security Card
Not provided
Valid
Altered
Counterfeit
Upload File(s): Social Security Card
Resident Alien Card
Not provided
Valid
Altered
Conterfeit
Upload File(s): Resident Alien Card
Employment Authorization
Not provided
Valid
Altered
Counterfeit
Upload File(s): Employment Authorization
I-94
Not provided
Valid
Altered
Counterfeit
Upload File(s): I-94
Passport
Not provided
Valid
Altered
Counterfeit
Upload File(s): Passport
Out-of-State ID/DL
Not provided
Valid
Altered
Counterfeit
Upload File(s): Out-of-State ID/DL
Were other documents presented?
Yes
No
Other Documents
*
Upload File(s): Other Documents
Narrative/Comments (Please include date and time.)
*
disregard this