Request for Investigation

Details
Attachments

Please provide as much information as possible. Leaving fields blank may make it difficult to initiate an investigation.

First Name

Last Name

Street

Apt.

City

State

Zip

Complainant Email

Your Relationship to Child(ren) Involved

Primary Phone Number

Primary Phone Ext

Primary Phone Type

Alternate Phone Number

Alternate Phone Ext

Alternate Phone Type

Child 1 Information (Please provide as much information as possible. Leaving fields blank may make it difficult to initiate an investigation.)

First Name

Last Name

Foster Home or Other Placement

Birthdate

Enter Date (DD/MM/YYYY)

Street

Apt

City

State

Zip

Phone

Child 2 Information

First Name

Last Name

Foster Home or Other Placement

Birthdate

Enter Date (DD/MM/YYYY)

Street

Apt

City

State

Zip

Phone

Child 3 Information

First Name

Last Name

Foster Home or Other Placement

Birthdate

Enter Date (DD/MM/YYYY)

Street

Apt

City

State

Zip

Phone

Child 4 Information

First Name

Last Name

Foster Home or Other Placement

BirthDate

Enter Date (DD/MM/YYYY)

Street

Apt

City

State

Zip

Phone

Staff Details (Please provide as much information as possible. Leaving fields blank may make it difficult to initiate an investigation.)

Staff Person's First Name

Staff Person's Last Name

Child Welfare Employer

Staff Person's Title

Address 1

Address 2

City

State

Zip

Primary Phone Number

Primary Phone Ext

Primary Phone Type

Alternate Phone Number

Alternate Phone Ext

Alternate Phone Type

Staff Person's email

Supervisor's First Name

Supervisor's Last Name

Complainants are encouraged to resolve issues with workers or supervisors. Have you attempted to resolve this issue with the supervisor or private agency Director?

Date

Enter Date (DD/MM/YYYY)

If yes, please explain

Have you attempted to resolve this issue through Service Appeal or other Administrative Process?

If yes, please explain

Are the facts of this complaint the subject of a pending court or administrative case?

Divorce/Custody

Paternity

Child Support

The OIG may only investigate wrongdoing of DCFS employees, private agencies, or private agency employees, contractors, and foster parents. Please describe what DCFS or its contracting agency did or failed to do that you believe may have been improper. Be as specific as possible and include information such as dates, times, places, names, and telephone numbers or other persons involved. Attach copies of any documents that support your complaint.

Required

Consent

I verify the contents of this request are true and accurate to best of my knowledge.