Form Soc 342 - Report Of Suspected Dependent Adult/elder Finantial Abuse Page 3
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3GENERAL INSTRUCTIONS (Continued)
FAILURE TO REPORT
Officers or employees of financial institutions (defined under “Reporting Party Definitions”) are mandated reporters of
financial abuse (effective January 1, 2007). These mandated reporters who fail to report financial abuse of an elder or
dependent adult are subject to a civil penalty not exceeding $1,000. Individuals who willfully fail to report financial abuse
of an elder or dependent adult are subject to a civil penalty not exceeding $5,000. These civil penalties shall be paid
by the financial institution, which is the employer of the mandated reporter to the party bringing the action.
WRITTEN REPORT
If any item of information is unknown, write "unknown" beside the item.
1. Part A: Victim Provide information as indicated to the extent known to you or available from financial institution
records. If the apparent victim is residing at a location other than his or her address of record, indicate in "Present
Location."
2. Part B: Incident Information Please check the appropriate box to indicate where the incident occurred. If the
incident occurred at another location, please enter the address of the incident location.
3. Part C: Reporter's Observations Complete this part carefully and completely. Please include any of the
following, as applicable:
Statements made by the apparent victim or the suspect;
Changes to banking patterns or practices; unusual account activity, such as large withdrawals or large wire
transfers;
Abrupt changes to legal or financial documents, such as a power of attorney or trust instrument;
Sudden confusion by the apparent victim regarding his or her personal financial matters;
Repeated telephone calls to the financial institution by the apparent victim repeatedly asking the same
question(s);
Establishment of unnecessary credit for the apparent victim himself or herself or another person;
Apparent victim's belief that he or she has won a lottery;
Observations regarding changes to the apparent victim's appearance or demeanor, etc.; or
Other concerns by the financial institution's officer or employee not listed above.
Please attach additional pages, if necessary.
4. Part D: Targeted Account Complete information as indicated regarding the targeted account of the apparent
victim. To ensure confidentiality, indicate only the last 4 digits of that account number. When making the report by
telephone, the mandated reporter will be asked to provide the full account number. A trust account includes not only
a Totten or informal trust arrangement through a deposit account, but also formal trust arrangements through a
financial institution's trust department. If the apparent victim has other accounts with the financial institution, check
"yes." If more than one account is affected, indicate on separate page.
5. Part E: Suspect Information
This information is of particular importance to an agency's ability to conduct an
investigation. Attach additional pages if more than one suspect is involved.
6. Part F: Other Persons Believed to Have Knowledge of Abuse This section is intended to identify any other
persons who have knowledge of the incident(s).
7. Part G: Telephone and written reports This part shall be completed by the mandated reporter for statistical
reporting to financial institutions, and county, state, and federal entities.
8. Distribution of SOC 342 copies The mandated reporter shall send the original and one copy to the appropriate
agency, after the telephone report is made; keep one copy for the reporter’s file. The receiving agency shall place
the original copy in the case file and send a copy to the cross-reporting agency, if applicable. DO NOT SEND A
COPY TO THE CALIFORNIA DEPARTMENT OF SOCIAL SERVICES ADULT PROGRAMS OPERATIONS
BUREAU.
SOC 342 (12/06) GENERAL INSTRUCTIONS
PAGE 2 OF 2
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