Fillable Demand for Payment of Wage: Instructions and Information (Colorado DORA)

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Demand for Payment of Wage: Instructions and Information (Colorado DORA)

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THIS FORM MUST BE SENT TO THE EMPLOYER, NOT TO THE DIVISION OF LABOR STANDARDS
AND STATISTICS. THIS FORM DOES NOT INITIATE A WAGE COMPLAINT WITH THE DIVISION.
Demand for Payment of Wage: Instructions and Information
This Demand for Payment of Wages form is filled out by the employee and then sent to the current or former
employer who owes the wages for work performed in Colorado. Pursuant to 7 CCR 1103-7, Rule 2.14, wages must
be owed at the time of sending the written demand to be considered valid.
Please note:
You are not required to send a written demand for payment of wages to the current or former employer.
Sending a written demand to your current or former employer may assist you in recovering your wages.
Sending a written demand may also increase the chance of obtaining monetary penalties from your
employer if you subsequently pursue the matter in Court or with the Division.
Pursuant to C.R.S. § 8-4-109(3)(a), “[i]f an employer refuses to pay wages or compensation . . . the employee, his
or her designated agent, or the division may send a written demand for the payment.” If an employer fails to pay
the wages or compensation due to the employee within fourteen days after the written demand is sent, “the
employer shall be liable to the employee for the wages or compensation, and a penalty.” C.R.S. § 8-4-109(3)(b).
1. Please follow these guidelines when using this form:
Fill out the form completely, including the date and your signature.
Make a photocopy of the form for your records.
SEND THE ORIGINAL FORM TO THE EMPLOYER WHO OWES YOU WAGES.
Send the form to the employer’s correct address.
You may wish to send the form via certified mail so there is a record of mailing and receipt.
Keep any other records that may prove when, and to whom, you sent this form.
Do NOT send this form to the Division of Labor Standards and Statistics. This form does not initiate
a wage complaint with the Division.
2. If you would like the Division to assist you in recovering your wages:
You MUST fill out a separate Wage Complaint Form. See the Wage Complaint Instructions and
Frequently Asked Questions for more information.
If you do not send this Demand for Payment of Wages form to your employer, the Division’s Notice of
Complaint constitutes a written demand for legal purposes. C.R.S. § 8-4-111(5).
3. If the employer does not pay your wages within 14 days after the demand for payment, the Division may
order the employer to pay you the greater of the following penalties:
125% of the wages due,
OR
Your average daily earnings for each day (up to ten days) until payment is made. C.R.S. § 8-4-109(3)(b).
Penalties may increase by 50% if the withholding of wages is found to be willful.
In addition to the possible penalties, the Division may also order the employer to pay a fine (payable to the
State of Colorado) of up to $50 per day for every day the employer fails to pay your wages.
4. If you would prefer to go to Court to pursue your wages:
You may pursue the matter in Court without contacting the Division. The Division wage complaint
process is not required and is not a prerequisite for independent legal action.
If you have already pursued the wage complaint in Court, you may not subsequently use the Division
process to address the same wage complaint that you pursued in Court.
Please note: This form is provided by the Colorado Division of Labor Standards and Statistics for informational purposes
only. The Division cannot provide legal advice related to the validity of any specific claims. If you need legal advice
regarding your specific circumstances, please consult an attorney.
August 2019
THIS FORM IS PROVIDED BY DIVISION AS AN ADMINISTRATIVE COURTESY.
THE DIVISION HAS MADE NO DETERMINATION AS TO THE VALIDITY OF THE DEMAND.
August 2019
DEMAND FOR PAYMENT OF WAGES
TO:
FROM:
(EMPLOYER/BUSINESS/COMPANY NAME)
(EMPLOYEE NAME)
(OWNER/OFFICER/MANAGER)
(JOB TITLE)
(STREET ADDRESS)
(STREET ADDRESS)
(CITY, STATE, ZIP)
(CITY, STATE, ZIP)
Dear Employer,
You owe me outstanding wages or compensation. According to Colorado law:
All wages and compensation shall be due and payable on regular paydays no later than ten days
following the close of each pay period unless the employer and the employee mutually agree on an
alternative period. C.R.S. § 8-4-103(1)(a).
If termination of employment by the employer occurs, wages and compensation are due and payable
IMMEDIATELY unless one of the following exceptions is met:
1. If the employer’s accounting unit, responsible for payroll checks is not regularly scheduled to be
operational, wages are due and payable no later than six hours after the start of the employer’s
accounting unit’s next regular workday, or
2. If the employer’s accounting unit is located off the work site, the employer shall deliver the check
for wages due no later than twenty-four hours after the start of the accounting unit’s next regular
workday. C.R.S. § 8-4-109(1)(a).
If the employee quits or resigns, wages and compensation are due and payable upon the next regular
payday. C.R.S. § 8-4-109(1)(b).
I hereby make a formal demand of payment of wages and compensation due me in accordance with Title 8,
Article 4 of Colorado Revised Statutes, as amended. Refusal to pay within 14 days of the sending of this
demand may subject you to a penalty of 125% of the amount owed, or up to 10 days of my average daily
earnings, whichever is greater, pursuant to C.R.S. § 8-4-109. In addition, fines of up to 50 dollars per day
commencing from the date that such wages first became due and payable may be assessed, pursuant to C.R.S.
§ 8-4-113.
I AM OWED APPROXIMATELY $_________________ FOR THE FOLLOWING WAGES OR COMPENSATION:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
(Employee Signature)
(Date Sent)
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Demand for Payment of Wage: Instructions and Information (Colorado DORA)

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Completed 20 July 2020

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