# Preliminary Witness Statement Forms Please complete a *Preliminary Witness Statement* and provide a detailed description of the incident that you observed or what was reported to you. This should include dates, times and names. Please note that if you remember additional information after completing this form, you should call the QA/CC Department at your earliest convenience. All information provided is confidential and should not be shared with others. Return the completed form to the QA/CC Department via email to or by mail to Independent Support Services, Inc., ATTN: QA/CC, 380 Rabro Drive, Hauppauge NY 11788 [Preliminary Witness Statement Fillable (PDF)](https://help.issny.org/attachments/102) English, Fillable Revised Jan. 2021 [Preliminary Witness Statement Spanish (PDF)](https://help.issny.org/attachments/104) Spanish Revised 04/02/26 --- Created 04/02/26.