WIC Vendor or Grocery Store Fraud Reporting Form

(Only applicable if a Vendor)
(First)
(Last)
(Please enter the phone number in XXX-XXX-XXXX format)

In the box below, please provide a description of the suspected WIC Vendor fraud. Be sure to include the important details such as names of persons suspected and dates if available.

You are able to report suspected WIC Vendor fraud anonymously, but if you would like the WIC State Agency to contact you, please complete the fields below: