NCUA Fraud Hotline Form

The purpose of the NCUA Fraud Hotline is to identify fraud concerns associated with insider activities by current or former credit union employees, directors, or committee members (such as supervisory committee, audit committee, credit committee, etc.). If you are a consumer with a complaint concerning your account or loan at a federally insured credit union, please contact the NCUA’s Consumer Assistance Center.

Questions marked with * are required.

1. How would you prefer to provide your information or concerns to the NCUA?

I want to remain anonymous (If you select this option, do not identify yourself below).

I agree to provide my contact information to appropriate NCUA personnel and/or state supervisory personnel, as appropriate.

1a. If so, you may be contacted at:

Phone

2. Are you (or have you ever been) a member, employee, board member, auditor, volunteer, or otherwise affiliated with the subject credit union?

Yes

2a. If you selected Yes above, please specify whether you are current or former.

Former

Current

3. What is the name and location of the credit union you have fraud concerns about?

Credit Union Name

Credit Union Address or Location

4. In your own words and in as much detail as possible, please explain what is happening and what you have witnessed at the credit union which leads you to believe fraudulent conduct occurred.

5. When did the fraudulent conduct begin, and where did it occur?

6. What are the names of the employee(s) involved?

Please add one employee name per line.

7. Have others told you about these events?

Yes

7a. If yes above, please provide the names and contact information for these individuals.

Individual Contact Name 1

Individual Contact Phone Number 1

Individual Contact Email 1

Individual Contact Name 2

Individual Contact Phone Number 2

Individual Contact Email 2

Individual Contact Name 3

Individual Contact Phone Number 3

Individual Contact Email 3

8. Are you aware of any supporting documents or emails that can provide evidence of the fraudulent conduct?

Yes

8a. If you are aware, please explain.

9. Are you aware of any additional information that could assist us in looking into this matter?

Yes

9a. If yes above, please explain.

Privacy Act Statement

AUTHORITY: 12 U.S.C. 1766, 1786, 1787, and 1789; 28 U.S.C. 2671-2680. Disclosure of the requested information is not mandatory.

PURPOSE: To evaluate safety and soundness concerns and determine appropriate supervision plans related to fraud or other violations of the Federal Credit Union Act.

ROUTINE USE(S): Information you provide may be shared with parties outside the NCUA to conduct examination and supervision activities, including other regulatory agencies, law enforcement, or as required by law. A complete list of Routine Uses is available at NCUA-13, Litigation Case Files, 75 FR 41539.

EFFECTS OF NON-DISCLOSURE: Submitting a fraud tip or concern is voluntary, however insufficient details or information will prevent the NCUA from assessing potential fraud risks or taking appropriate actions.

SORN: NCUA-13, Litigation Case Files, 75 FR 41539.