Veteran Complaint Form

Veteran Complaint Form
To better assist veterans and service members, the Minnesota Attorney General’s Office has created this form to help veterans, service members, and their families report companies and individuals claiming to provide veterans benefits assistance. If you or someone you know was possibly scammed by a company or individual claiming to assist with securing veterans benefits, please complete this form.

Thank you for your report and your service.

* indicates required field
Are you a veteran?
Are you filling out this form on behalf of a veteran?
*If yes, please fill out the remainder of this form using the veteran’s information, not your own.
Your Information
Your Name

First NameLast Name
Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your Email
example@example.com
Veteran's Information

(If submitting on behalf of a veteran)
Veteran's Name

First NameLast Name
Veteran's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veteran's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Veteran's Email
example@example.com
Are you working with a Veterans Service Officer?
Officer's Name

First NameLast Name
Officer's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Office Location
Company Complained About
Name of Company You Are Complaining About
Contact Person

First NameLast Name
Contact Person Title
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Company Email and/or Website
Complaint Information
What type of Veterans' Benefits were/are you seeking (Select all that apply)

Other
Have you paid any money to the Company?
If yes, approximately how much?
Have you received or signed a Contract? *If yes, please attach a copy of the contract to this complaint form.*
Explanation of the Problem
Attachments

Max total file size limitation: 10 MB. Accepted file types: pdf, doc, docx, xls, xlsx, csv, mp3, jpg, jpeg, png, gif.
Cancelof
By choosing ‘Accept’ below, I acknowledge and/or consent to the following terms. The information I am providing will be used by the Minnesota Attorney General’s Office (“AGO”) to: (a) assist in the AGO’s enforcement of consumer-protection laws; (b) attempt to resolve the issue about which I am contacting the Office; (c) communicate with me; and (d) and otherwise assist in enforcing the law. I understand that the information I provide will be accessible to AGO staff and agents whose work assignments reasonably require access, to the state or legislative auditors, to other entities authorized by state or federal law, to persons authorized pursuant to a court order, and to others subject to my informed consent. For the purposes described herein, I consent to the AGO disseminating information I provide to other law enforcement agencies or other consumer-assistance agencies. I understand that I am not legally required to provide the information I have submitted or to consent to its release, but my failure to do so may make it more difficult to resolve my concerns. I understand that the AGO does not control the use or dissemination of information provided to third parties pursuant to my consent. Except as otherwise authorized by this consent, I understand that the information I am providing will be treated as “confidential data on individuals” or “private data on individuals” under the Minnesota Government Data Practices Act, Minn. Stat. ch. 13, and shall not be used or disseminated except as authorized under the Act or other applicable state or federal law.*
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Veteran Complaint Form

Your Information

Veteran's Information

Company Complained About

Complaint Information