Report FAMLI Fraud or Suspicious Activity: For Individuals
Important Information
Use this form for all suspected FAMLI fraud or suspicious activity. If you have received a Reliacard debit card or any correspondence, electronic or otherwise, from the Colorado Department of Labor and Employment (CDLE), but you have not filed a FAMLI claim, please report it to us via this form. Use this same form if you have received any correspondence to your mailing address that was sent to someone else other than those in your household.
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 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 division.
Contact Information
Please insert your contact information so that an ACE Supervisor can reach out to you, if required.
Your First Name
Your Middle Initial
Optional: Include this only if a middle initial appears on the correspondence you received.
Your Last Name
Your Phone Number
Please enter a valid ten-digit phone number without special characters.
Your Email Address
What type of Fraud and/or suspicious activities are you reporting?
My identity, or personal identifying information, was used to file a FAMLI claim
I received a suspicious FAMLI correspondence with someone else's name
I know of someone fraudulently claiming or collecting FAMLI benefits
I know of someone creating and/or collecting a fictitious FAMLI claim (i.e. fake Identity information, fake Employment, fake medical condition, fake Health Care Provider, etc.)
I received a suspicious text or email regarding my FAMLI claim
If the correspondence you received is in your maiden name, select "
My identity, or personal identifying information, was used to file a FAMLI claim.
"
If you are an employer but the correspondence is in your name, select "
My identity, or personal identifying information, was used to file a FAMLI claim.
"
My Identity Was Used to File A FAMLI Claim
Please complete the following details:
Did you previously receive benefits and now believe that the claim has been compromised?
Yes
No
If you received a piece of correspondence addressed to a name different than your own, please enter the name as it appears on the correspondence:
This might be different from the way your name is usually written. Sometimes, the FAMLI claim will be filed with the last name as the first name and the first name as the last name, or it may have been filed using your maiden name. If there is a middle initial, please include that as well.
Your Claim Information - First Name
Your Claim Information - Middle Initial
Your Claim Information - Last Name
Your Date of Birth
Please use format MM/DD/YYYY
Your Full Social Security Number
Please enter the 9 digits - no spaces or dashes
FAMLI 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.
Your Street Address (or Mailing Address)
Please only put the house number and street name (or PO Box) in this field, including Apt #, Suite, or Floor details. You will have unique fields for City, State, and Zip Code / Postal Code below.
Your City
Your State
Please add the two alpha characters.
Your Zip Code / Postal Code
Please add the five or nine-digit number for Zip Code your your Postal Code.
I received suspicious FAMLI correspondence with someone else's name
Please enter the name and address information as they appear on the card or correspondence.
This might be different from the way your name is usually written. Sometimes, the FAMLI claim will be filed with the last name as the first name and the first name as the last name, or it may have been filed using your maiden name. If there is a middle initial, please include that as well.
Please enter the First Name as it appears on the card or correspondence
Please enter the Middle Initial as it appears on the card or correspondence
Please enter the Last Name as it appears on the card or correspondence
If you received more than one piece of correspondence to the same address with different names and/or Claimant IDs, please click 'Add Another Name', below.
Street Address / Mailing Address (house number and stree name) or P.O. Box, including Apt#, Suite, Floor, etc.
NOTE: Enter the mailing address in the center of the return envelope.
City
NOTE: Enter the mailing address in the center of the return envelope.
State
NOTE: Enter the mailing address in the center of the return envelope.
Zip Code / Postal Code
NOTE: Enter the mailing address in the center of the return envelope.
I know of someone fraudulently claiming or collecting FAMLI benefits
Suspected Individual's Information. Please provide the following details about the person suspected of claiming or collecting FAMLI benefits inappropriately. Complete as many of the following fields as possible. All of the information in this section refers to the person suspected.
First Name of the Employee
Enter First Name of the Colorado state employee fraudulently claiming or collecting FAMLI benefits
Middle Initial of the Employee
Last Name of the Employee
Enter First Name of the Colorado state employee fraudulently claiming or collecting FAMLI benefits
Employee's Phone Number
Enter the Phone Number of the Employee claiming or collecting FAMLI Benefits inappropriately. Enter the ten-digit phone number with no spaces, dashes, or special formatting.
Employee's Email Address
Enter the email address of the Colorado state employee fraudulently claiming or collecting FAMLI benefits
Employee's Street Address / Mailing Address
Enter the house number and Street Name (or P.O. Box) of the Employee claiming or collecting FAMLI Benefits inappropriately. Enter Apt. #, Suite, or Floor details in this field. City, State, and Zip Code will be below.
Employee's City
Enter the City for the Employee claiming or collecting FAMLI benefits inappropriately.
Employee's State
Enter the State for the Employee claiming or collecting FAMLI benefits inappropriately.
Employee's Zip Code or Postal Code
Enter the Zip Code / Postal Code for the Employee claiming or collecting FAMLI benefits inappropriately.
Name of Business or Employer
Enter the name of the business or place of employment at which the individual is working while claiming or collecting FAMLI benefits inappropriately.
Employer's Phone Number
Enter the Employer's Phone Number. Enter the ten-digit phone number with no spaces, dashes, or special formatting.
Employer's Street Address / Mailing Address
Enter the Employer's Street Name (or P.O. Box). Enter Apt. #, Suite, or Floor details in this field. City, State, and Zip Code will be below.
Employer's City
Enter the City for the Employer.
Employer's State
Enter the State for the Employer.
Employer's Zip Code or Postal Code
Enter the Zip Code / Postal Code for the Employer.
I know of someone fraudulently creating or collecting a fictitious FAMLI claim (i.e. fake identity information, fake employment, fake medical condition, fake Health Care Provider, etc.)
Suspected Individual's Information. Please provide the following details about the person suspected of creating of collecting a fictitious FAMLI claim. Complete as many of the following fields as possible. All of the information in this section refers to the person suspected.
First Name of the Individual
Enter First Name of the individual suspected of creating or collecting a fictitious FAMLI claim
Middle Initial of the Individual
Last Name of the Individual
Enter First Name of the individual suspected of creating or collecting a fictitious FAMLI claim
Individual's Phone Number
Enter the Phone Number of the individual suspected of creating or collecting a fictitious FAMLI claim. Enter the ten-digit phone number with no spaces, dashes, or special formatting.
Individual's Email Address
Enter the email address of the
individual suspected of creating or collecting a fictitious FAMLI claim.
Individual's Street Address / Mailing Address
Enter the house number and Street Name (or P.O. Box) of the individual suspected of creating or collecting a fictitious FAMLI claim. Enter Apt. #, Suite, or Floor details in this field. City, State, and Zip Code will be below.
Individual's City
Enter the City for the individual suspected of creating or collecting a fictitious FAMLI claim.
Individual's State
Enter the State for the individual suspected of creating or collecting a fictitious FAMLI claim.
Individual's Zip Code or Postal Code
Enter the Zip Code / Postal Code for the individual suspected of creating or collecting a fictitious FAMLI claim.
Name of Business or Employer
Enter the name of the business or place of employment related to the individual suspected of creating or collecting a fictitious FAMLI claim.
Employer's Phone Number
Enter the Employer's Phone Number. Enter the ten-digit phone number with no spaces, dashes, or special formatting.
Employer's Street Address / Mailing Address
Enter the Employer's Street Name (or P.O. Box). Enter Apt. #, Suite, or Floor details in this field. City, State, and Zip Code will be below.
Employer's City
Enter the City for the Employer.
Employer's State
Enter the State for the Employer.
Employer's Zip Code or Postal Code
Enter the Zip Code / Postal Code for the Employer.
I received a suspicious text or email message about my FAMLI claim.
Did you click on the link in the message?
Yes
No
Are you still able to access your My FAMLI+ account?
Yes
No
Any other details about the suspicious text?
Share the phone number from the text.
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 boxes below:
I certify that I have answered the questions in form truthfully. I understand that there are penalties for providing false or misleading information.
Yes, I agree
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