Complaint Against Participant Complaint Against WIC Participant Anonymity I would like to be anonymous Witness Contact InformationName First Last Home PhoneCell PhoneEmail EmployerComplaint TypeYou may check up to four (4) complaint types. Attempting to purchase foods not approved by WIC Threatening or verbally abusive towards cashiers or WIC staff Physically abusive towards cashiers or WIC staff Causing clinic/store disruption Inappropriate use of food instruments (no signature, using early) Misrepresentation of eligibility information (income, family size) Dual Participation Sale of WIC items obtained through WIC(formula, breast pumps) Exchanging food instrument(s) for credit or non-food items Altering food instruments Using food instruments at an unauthorized store Stealing WIC food instruments Stealing WIC foods Trafficking of items obtain through WIC (formula, food instruments) Record Request Complaint InformationDate of Incident Date Format: MM slash DD slash YYYY Time of Incident : HH MM AM PM Which clinic?UnknownBattle Mountain Family Resource - Clinic #403 - 470 South Broad Street, Battle Mountain, NV 89820Carson City Health and Human Services - Clinic #427 - 1538 Hwy 395 Suite 220, Gardnerville, NV, 89410Carson City Health and Human Services - Clinic #455 - 900 East Long Street, Carson City, NV 89706Consolidated Agencies of Human Services - Clinic #409 - 924 5th Street, Hawthorne, NV, 89415Family Resource Centers of Northeastern NV - Clinic #417 - 331 7th Street, Elko, NV, 89801Lyon County Human Services - Clinic #419 - 26 Nevin Way #5, Yerington, NV, 89447Lyon County Human Services - Clinic #420 - 170 Pike Street, Dayton, NV, 89403Lyon County Human Services - Clinic #424 - 460 West Main Street, #109, Fernley, NV, 89408Lyon County Human Service - Clinic #428 - 2965 Fort Churchill Rd, Silver Springs, NV, 89429Little People's Head Start - Clinic #426 - 460 West Main Street, #109, Ely, NV, 89408Inter-Tribal Council of Nevada - 680 Greenbrae Suite 222, Sparks, NV, 89431Pershing County WIC - Clinic #421 - 775 Cornell Street, Lovelock, NV, 89419Pershing County WIC - Clinic #422 - 26 E. Haskell Street, Suite B, Winnemucca, NV, 89445Pershing County WIC - Clinic #425 - 295 E. Williams, Suite B, Fallon, NV, 89406Ron Wood Family Resource Center - Clinic #423 - 2621 Northgate Lane #62, Carson City, NV, 89706Neighborhood Health Clinic - CHA - Clinic #312 - 3915 Neil Road, Reno, NV, 89502Sun Valley Clinic - CHA - Clinic #313 - 5295 Sun Valley Blvd Suite #8, Sun Valley, NV, 89433Sparks Clinic - CHA - Clinic #314 - 921 12th St Suite C, Sparks, NV, 89431Sutro Head Start Clinic - CHA - Clinic #315 - 1100 East 8th Street, Reno, NV, 89512Wooster Early Childhood Clinic - CHA - Clinic #316 - 1950 Villanova Rd, Reno, NV, 89502WIC on Wheels - CHA - Clinic #317 - Mobile ClinicBurns Clinic - CHA - Clinic #318 - 1055 South Wells Avenue, Reno, NV, 89502Washoe County Health District - South Reno Clinic - Clinic #301 - 601 West Moana #3, Reno, NV, 89509Washoe County Health District - Wells Clinic - Clinic #302 - 1001 East 9th Street, Reno, NV, 89502Washoe County Health District - Incline Clinic - Clinic #306 - 865 Tahoe Boulevard #202, Incline Village, NV, 89451Owens Clinic - Catholic Charities - Clinic #801 - 1511 Las Vegas Blvd N., Las Vegas, NV, 89101Henderson Clinic - Catholic Charities - Clinic #802 - 270 E. Horizon Suite 109, Henderson, NV, 89015Nellis AFB Clinic - Chatholic Charities - Clinic #803 - 4349 Duffer Drive, Las Vegas, NV, 89191M.L.K. Clinic - Nevada Health Centers - Clinic #204 - 1700 Wheeler Peak Drive, Las Vegas, NV, 89106Tropicana Clinic - Nevada Health Centers - Clinic #205 - 5225 E. Tropicana Ave. Suite D, Las Vegas, NV, 89122Arville Clinic - Nevada Health Centers - Clinic #206 - 4601 W. Sahara Suite I, Las Vegas, NV, 89102Gowan Clinic - Nevada Health Centers - Clinic #208 - 3650 N. Rancho Dr Suite 106, Las Vegas, NV, 89130Bonanza Clinic - Nevada Health Centers - Clinic #209 - 5001 E. Bonanza Rd Suite 104, Las Vegas, NV, 89110McDaniel Clinic - Nevada Health Centers - Clinic #601 - 2225 Civic Center Dr. Suite 150, Las Vegas, NV, 89030Cambridge Clinic - Nevada Health Centers - Clinic #602 - 3900 Cambridge Ave. Suite 102, Las Vegas, NV, 89119West Flamingo Clinic - Clark County Urban League - Clinic #650 - 6480 W. Flamingo Dr. Suite B, Las Vegas, NV, 89103East Flamingo Clinic - Clark County Urban League - Clinic #651 - 3320 E. Flamingo Suite 50, Las Vegas, NV, 89121Meadows Clinic - Sunrise Children's Foundation - Clinic #501 - 3838 Meadows Lane, Las Vegas, NV, 89107Sahara Clinic - Sunrise Children's Foundation - Clinic #502 - 1000 E. Sahara Ave. Suite 101, Las Vegas, NV, 89104North Clinic - Sunrise Children's Foundation - Clinic #503 - 3603 N Las Vegas Suite 110, Las Vegas, NV, 89115Mesquite Clinic - Sunrise Children's Foundation - Clinic #504 - 312 W. Mesquite Blvd. Suite 10, Mesquite, NV, 89027Tonopah Clinic - Nye County WIC - Clinic #406 - 1 Frankee Ave, Tonopah, NV, 89049Pahrump Clinic - Nye County WIC - Clinic #505 - 1981 E. Calvada Blvd. N. Suite 100, Pahrump, NV, 89048Henderson Clinic - St. Rose - Clinic #720 - 100 N. Green Valley Pkwy Ste. 215, Henderson, NV, 89074West Clinic - St. Rose - Clinic #721 - 7220 S. Cimarron Rd. Suite 195, Las Vegas, NV, 89113Caliente Clinic - Lincoln County - Clinic #412 - 360 Lincoln Street, Caliente, NV, 89008Participant Name First Last DescriptionAdditional Staff InvolvedWere additional Staff Involved?YesNoStaff Member Name First Last DescriptionWhat happened?Describe the Incident