Elder Consumer Protection Program: Scam Survey

	Please take part in our survey. This form is only used for gathering information. We do not ask for any personal information.

Please answer as many questions below as possible:

Tell Us About The Scam

Were you a victim of a scam within the last six months?
Yes:
No:
If yes, date of scam (mm/yyyy):
What Kind of Scam Was It? (Check All That Apply)
My identity was stolen:
I sent money to a sham charity:
I paid for home repairs that were never done, never finished or done poorly:
I never received a product by mail after I paid for it:
I had checks stolen and used without my consent:
I had my credit card stolen and used without my consent:
I was told I won the lottery and I sent money or bought something to get my winnings:
I gave my account number to someone who then used it to get my money without my permission:
I was sold an investment that was worthless or lesser value than promised:
Other:

What did you do after the scam occurred?

Did you report the scam?
Yes:
No:
If yes, to whom did you report? (Check all that apply)
Law Enforcement:
Attorney General:
Department of Agriculture:
Department of Finance:
Department of Insurance:
Other:
If you did not report the scam, why not? (Check all that apply)
Embarrassed:
Afraid:
Did not know who to call:
Not worth it:
Other (explain):

How Did The Scam Work?

How did you first learn about the scam offer?
Television:
Phone Call:
Door-to-door:
Mail:
Internet or email:
Other (explain):
Did the scam artist contact you because you responded to the offer?
Yes:
No:

Tell Us How Big A Problem Scams Are.

How often are you asked to buy something by mail, phone, or internet/email?
Never:
1 or 2 times a month:
Every day:
Several times a day:

How often do you respond (by buying something or doing something) to offers made to you by:
Mail:	Often:	Sometimes:	Never:
Phone:	Often:	Sometimes:	Never:
Infomercial:	Often:	Sometimes:	Never:
Internet/email:	Often:	Sometimes:	Never:

Thank You!

We Appreciate Your Help In Combating Elder Consumer Fraud. Please Click The Button Below To Submit Your Survey.