Any information reported on this form is confidential and will be kept confidential by Internal Audit in order to maintain the
integrity of the Fraud, Waste & Abuse Hotline reporting and investigation process. Because this form, when completed,
contains investigative notes and information furnished in confidence to Internal Audit, the completed form and its contents
are excluded from mandatory disclosure under the Virginia Freedom of Information Act. Virginia Code § 2.2-3705.3(7); 2.2-
3700 et seq.
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You may fill-in this form on-screen and submit it directly to the Internal Audit Department by selecting the submit button at the bottom or you may select the print button and either fax the form to 804-365-6878 or mail the form to: Internal Audit Department, P.O. Box 470, Hanover, VA 23069-0470.
We treat all information received as confidential. If you wish to remain anonymous, you may skip this section; however, we encourage you to provide this information in case we need to contact you for further information.
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