Report your concern about abuse, neglect or theft happening to a person with developmental disabilities

1. If someone is in danger, don’t wait! Call local law enforcement now.

2. The fastest way to report your concern is to contact your county board of developmental disabilities’ MUI Reporting Hotline.

3. Use this online reporting form to report a concern or call the DODD Abuse and Neglect Hotline during business hours at (866) 313-6733.

Bold fields are required.

Please correct the following errors
Section 1- (Optional)

Person making complaint

You can complete only if you wish to receive acknowledgement of your complaint.

If you would like to remain anonymous, please select Yes in the radio button.

Would you like to remain anonymous?  Yes    No

Section 2 - (Required)

Victim(s) information

Individual(s) with Developmental Disabilities involved in the complaint.

The Individual affected first/last name and county are required fields.

(Please enter NA if you don't know.)
(Please enter NA if you don't know.)

Section 3 - (Required)

Incident witnessed

Description of the Incident witnessed (Who, What, Where, When, How and Why). Please include details, duration, etc. You may include an attachment.
The Incident Type and Description are required fields.

(field is only applicable if Other chosen)
Must be 500 characters or less
Accepted Formats Include:JPG/JPEG/GIF/PDF/Word Document files
County Board
Other DODD Department
Another State Agency
Law Enforcement
Other

Agency name and/or person contacted.

Section 4 - (Optional)

Alleged Perpetrator/Primary Person Involved

Name of person/agency you are filing complaint about.

If this information is not available, please select No in the radio button.

Do you know any person/agency information you are filing complaint about?
 Yes    No

Section 5 - (Required)

Provider Information

Person and/or company providing services to individual.

If this information is not available, please select No in the radio button.
Correct Verification Words are required to submit the entry.

Do you know any provider information?    Yes    No

Are you sure you want to reset the form?