The Authorized Representative Form is the Colorado Division of Labor Standards and Statistics form that a claimant or an employer uses to name a third party to act for them in the Division's complaint process. It is one of the authorized representative form options used in Colorado labor complaints, and it covers both the investigation and the appeals process. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the Division, part of the Colorado Department of Labor and Employment (CDLE), receives it only through its own channels.
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What is Authorized Representative Form – Colorado?
The Authorized Representative Form is the Colorado Division of Labor Standards and Statistics form by which a claimant or an employer designates a person or organization to represent them in the Division's complaint process, within the Colorado Department of Labor and Employment (CDLE).
The Division's explanation on the form says the complaint process includes the investigation conducted by the Division's Complaint Investigators and the appeals process through the Division's Hearing Officer. A representative may assist in any aspect of it. Representatives may be attorneys, non-attorneys, relatives, non-relatives, or organizations.
In Section III, the person signing authorizes four things:
- The Division may release, furnish, provide, exchange and request any and all information about the specific complaint to the representative.
- The representative may do the same toward the Division.
- The representative may make any and all decisions about the specific complaint on the signer's behalf.
- By typing a name on the signature line, the signer represents being the individual identified as the claimant or employer at the top of the form.
The form is three pages. Section I is for the claimant or employer, Section II is for the representative, and Section III is the signature. The "For Internal Use Only" box with the complaint number and Compliance Investigator is for Division staff.
Who needs to file Authorized Representative Form – Colorado?
Claimants and employers who are involved in a complaint before the Division of Labor Standards and Statistics and want someone to assist them may designate a representative with this form. The Division's explanation says a representative can help in any aspect of the complaint process, including the investigation and the appeal before the Division's Hearing Officer.
The representative can be an attorney, a non-attorney, a relative, a non-relative, or an organization. Section II accepts either a person or an organization, so a person's name and an organization's name can both be entered.
The form is completed by the claimant or the employer, not by the representative. Section I is "to be filled out by the Claimant or the Employer," and the signer states that they are the individual identified as the claimant or employer at the top of the form.
Nothing on the form makes a representative mandatory. It applies only to the Division's complaint process, and it grants authority over "the specific complaint" it is signed for.
When to file Authorized Representative Form – Colorado
Submit the form when you decide to have a representative assist you in the Division's complaint process. The form sets no due date of its own. It applies to the investigation and to the appeals process, so submit it before the representative needs to communicate with the Division or act on your behalf in the complaint.
Once submitted, the authorization stays in place until you revoke it. The form says you may revoke it only by providing written notice to the Colorado Division of Labor Standards and Statistics.
How to fill out Authorized Representative Form – Colorado
Enter your name and phone numbers
In Section I, write Your First Name, Your Last Name, Your Primary Phone and, if you have one, Your Alternate Phone. Section I is for the claimant or the employer.
Enter your email and mailing address
Fill in Your Email Address, Your Mailing Address, City, State and Zip Code.
Enter the employer or business name
Write the Name of Employer/Business/Company that is connected to your complaint.
Enter the representative's name
In Section II, write the First Name and Last Name of Authorized Representative. If the representative is an organization, add its name under Name of Authorized Representative Organization (if applicable).
Enter the representative's address
Fill in the Mailing Address for Authorized Representative, with City, State and Zip Code.
Enter the representative's contact details
Write the representative's Phone Number, Fax Number and Email Address.
Read the authorization statement
Section III lists what you authorize: information exchange between the Division and the representative, and the representative's power to make decisions about the specific complaint on your behalf. Write your name in the blank after "I".
Sign and date the form
Enter Your Full Name, Your Signature and the Date (MM/DD/YYYY). By typing your name on the signature line you represent that you are the claimant or employer identified in Section I.
Review and download the completed PDF
Check that Sections I and II are complete and the name matches the signature. Download or print the completed PDF from FillingPDF and send it through one of the channels described under How to submit.
How to submit Authorized Representative Form – Colorado
You can submit the completed form to the Division by email, fax, mail, or in person.
- Mail or hand delivery: Division of Labor Standards and Statistics, 707 17th St Suite 2400, Denver, CO 80202.
- Fax: (303) 318-8400.
- Email: [email protected].
To revoke the authorization later, send written notice to the Colorado Division of Labor Standards and Statistics; the form says that is the only way to revoke it once it is submitted.
For questions, call the Division at (303) 318-8441 or email [email protected]. Division staff may answer questions about the process but may not discuss the facts of your case. Do not direct appeals-related questions to the Compliance Investigator who issued the determination. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Having someone other than the claimant or employer sign the form; the signer represents being the individual identified at the top of the form.
- Leaving out the signature or the date in MM/DD/YYYY format in Section III.
- Completing Section II with the representative's details but leaving Section I, including the name of the employer, business or company, unfinished.
- Writing in the "For Internal Use Only" box with the complaint number or Compliance Investigator; it is reserved for the Division.
- Sending a revocation by phone or informally; the form says revocation requires written notice to the Division of Labor Standards and Statistics.
- Signing without reading the authorization: the representative can make any and all decisions about the specific complaint on your behalf.
- Directing appeals-related questions to the Compliance Investigator who issued the determination, which the form tells you not to do.
- Mailing or delivering the form to the 707 17th Street address in the page header instead of Suite 2400 for mail or hand delivery.
Frequently asked questions
What is the Colorado Authorized Representative Form?
It is a Division of Labor Standards and Statistics form that lets a claimant or employer designate a person or organization to assist in the Division's complaint process. It covers the investigation by Complaint Investigators and the appeals process before the Hearing Officer.
Who can be my authorized representative?
The Division says a representative may be an attorney, a non-attorney, a relative, a non-relative, or an organization. Section II of the form accepts a person's name and, if applicable, the name of an organization.
Who has to sign the authorized representative form?
The claimant or the employer signs, not the representative. Section III states that by typing your name on the signature line you represent that you are the individual identified as the claimant or employer at the top of the form.
What authority does my representative get?
The Division may share and request any information about the specific complaint with the representative, and the representative may do the same toward the Division. The representative can also make any and all decisions about that complaint on your behalf.
Where do I send the authorized representative form?
Submit it by email to [email protected], by fax to (303) 318-8400, by mail or hand delivery to 707 17th St Suite 2400, Denver, CO 80202, or in person. All go to the Division of Labor Standards and Statistics.
How do I revoke an authorized representative?
Once the form is submitted, you can revoke the authorization only by giving written notice to the Colorado Division of Labor Standards and Statistics. The form names no other way to revoke it.
Can I fill out the authorized representative form online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is independent of the Division and does not submit the form; you send it to the Division by email, fax, mail, or in person.
Can Division staff discuss my case with me when I call?
No. Staff at (303) 318-8441 may answer questions about the process but may not discuss the facts of your case. Appeals-related questions should not go to the Compliance Investigator who issued the determination.
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