Report FAMLI Fraud or Suspicious Activity: For Business
Important Information
Colorado State Employers, please use this form for all suspected FAMLI program-related fraud or suspicious activity on behalf of your employees.
Please ALSO respond to any fact-finding questionnaires
you may receive from FAMLI in addition to filling out the below Fraud form.
To ensure a successful and thorough investigation, you should provide as much detail as possible about the alleged identity theft and/or fraud when completing this form.
Please note that this form is specifically for
State of Colorado
FAMLI claims. If someone has stolen your identity and used it to file a FAMLI claim in a different state, you must report it to the state's FAMLI program division.
Contact Information
Enter your primary contact information here, including a current email address where you can be reached. We may contact you for a follow-up if necessary.
Please understand that while it is important to keep your information confidential, we may be required to share your information with law enforcement if a criminal investigation begins.
Your First Name
Your Last Name
Your Phone Number
Please enter a valid ten-digit phone number without special characters.
Your Email Address
Your Business or Employer Name
Your Federal Employer Identification Number (FEIN)
This field is optional.
Your My FAMLI+ Employer Account Number
This seven-digit number should appear on any official paperwork you receive from the Department of Labor. Please note some non-claim related paperwork may have the Employer's account number listed as either: "123456007" or "123456.00-7". In that case, just enter the Employer account number without the zeros. For example, if the Employer account number is listed as "123456.00-7", you should enter "1234567".
Employee Information
Please note that you can submit multiple reports about separate employees by clicking the link at the bottom, up to 50 reports at a time.
Employee's First Name
Enter the first name of the Employee as it appears on the FAMLI correspondence you received.
Employee's Middle Initial
Optional: Include this only if a middle initial appears on the correspondence you received.
Employee's Last Name
Your Employee's Full Social Security Number
If the social security number on the FAMLI correspondence is different than the number in your records, please enter the number as it appears on the FAMLI correspondence.
Without a complete social security number, it will take additional time to locate and place a hold on any potentially fraudulent FAMLI program claims.
You may only have the last four digits of the claimant's social security number. If so, please provide the number with five leading zeros and the last four digits (for example, if the last four digits on the form are xxx-xx-1234, please enter the SSN in this format: 000001234). While we will attempt to investigate all reports with incomplete SSNs, we can not provide an estimate on how long that investigation may take.
Please enter the 9 digits - no spaces or dashes.
Employee's Claimant ID
(Optional) If any correspondence you received includes a "Claimant ID", please include that number here. It is an eight-digit number which usually started with a "1" or "2". There should be no special characters or punctuation marks. The Claimant ID is usually found under the date near the top of the form.
Did this person work for your company?
Yes, a person with this name and SSN worked (or still works) for me.
No, no person with this name or SSN worked for me.
A person with this SSN worked (or still works) for me, but the name is different.
A person with this name worked (or still works) for me, but the SSN is different
Attestation
What other details do you need to share about this Fraud situation not already covered in a previous question?
Please confirm this statement by checking the box(es) below:
I certify that I have answered the questions in the form truthfully. I understand that there are penalties for providing false or misleading information.
Yes, I agree
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