OIG Referrals: UpdatedHow to Fill Out an OIG-1 Form

The OIG-1 form can be found on the InfoNet under Forms, and Search for OIG-1. The form is a Word Document that can be completed on the computer and then printed out. The form would then be sent to OIG via fax or inter-agency mail, along with any supporting documentation. The OIG-1 form can also be emailed as an attachment.

If an overpayment exists and the probable overpayment amount is less than $500, consider submitting the information to the Benefit Integrity and Recovery Section (BIRS). If the probable overpayment is more than $500, or if trafficking of SNAP benefits is involved, an OIG-1 form should be completed and sent to OIG. Do not send the information to both places. OIG and BIRS work closely together so sending the information to both places could result in the case being worked twice.

Below is an example of an OIG-1 form and how it should be completed.

OIG 1 Form

  • Source of Referral: Name of Person Submitting the Information to OIG
  • Regarding: Name of Person Being Referred to OIG
  • ID No: Client’s Case Number
  • Address: Address of Person Being Referred to OIG
  • PH No: Client’s Phone Number
  • SSN: Client’s Social Security Number
  • DOB: Client’s Date of Birth
  • Basis of Referral: Tell the whole story here. Document how you came across the information, what verifications led you to believe fraud is occurring, any actions taken (ADM-92/ADM-94’s sent, phone calls, etc.), client/3rd party responses, possible timeframes of client overpayment, or fraud. Provide as much information as you know about the situation.
  • Supervisor’s Signature: Worker’s Supervisor Signs Here
  • Date: Date of Signature
  • Initiating Office: County Office Making the Referral
  • PH No: Worker’s Phone Number

Attach copies of relevant documentation such as: Falsified Forms, Overpayment Computation, Narrative and/or such other information as pertinent to the referral, not to exceed three years. If emailing the referral, the verifications can be included in the email as attachments. Also be sure to document in case notes all information regarding the referral.

OIG -1 Referral Forms can be sent to OIG by:

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