CO FAMLI provides up to 12 weeks of paid leave (plus 4 weeks for pregnancy/childbirth complications)

Benefits are up to 90% of average weekly wage for lower-income workers, with a state maximum cap

Self-employed workers can opt in to FAMLI coverage

Employment / FMLAmoderate

Colorado Family and Medical Leave Insurance Application

CO FAMLI · Colorado Department of Labor and Employment

Application for Colorado FAMLI (Family and Medical Leave Insurance). Provides up to 12 weeks of paid leave for medical conditions, bonding, caregiving, or qualifying exigencies.

Form Details

Total fields: 34
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Filled by: patient
Frequency: per incident
State-specific: Yes — form may vary by state

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Where to Submit This Form

🌐

FAMLI portal (recommended)

https://famli.colorado.gov/

Apply through Colorado's FAMLI portal.

Filing Deadline

File within 30 days of the start of leave. You may file in advance for foreseeable leave.

Required Attachments

📎 Medical certification from your healthcare provider
📎 Documentation of qualifying event
📎 Employer information and wage history

Processing Time

Approximately 2-3 weeks from receipt of a complete application.

What Happens Next

FAMLI Division will review and determine eligibility. If approved, weekly benefits are based on your wages (up to 90% for lower-wage workers).

Tips for This Form

✓ CO FAMLI provides up to 12 weeks of paid leave (plus 4 weeks for pregnancy/childbirth complications)
✓ Benefits are up to 90% of average weekly wage for lower-income workers, with a state maximum cap
✓ Self-employed workers can opt in to FAMLI coverage
✓ More info: https://famli.colorado.gov/

More Employment / FMLA Forms

FMLA Certification - Employee's Serious Health Condition

WH-380-E · U.S. Department of Labor

Certification of Health Care Provider for Employee's Serious Health Condition. Medical certification for FMLA leave for the employee's own condition.

FMLA Certification - Family Member's Serious Health Condition

WH-380-F · U.S. Department of Labor

Certification of Health Care Provider for Family Member's Serious Health Condition. Medical certification when employee needs leave to care for a family member.

FMLA Notice of Eligibility and Rights & Responsibilities

WH-381 · U.S. Department of Labor

Notice of Eligibility and Rights & Responsibilities. Employer must provide within 5 business days of FMLA leave request, stating whether employee is eligible.

FMLA Designation Notice

WH-382 · U.S. Department of Labor

Designation Notice. Employer designates leave as FMLA-qualifying or denies it. Must be provided within 5 business days of receiving sufficient certification.

FMLA Certification - Qualifying Exigency (Military)

WH-384 · U.S. Department of Labor

Certification of Qualifying Exigency for Military Family Leave. For leave due to a covered family member's active duty or call to active duty.

FMLA Certification - Serious Injury/Illness of Servicemember

WH-385 · U.S. Department of Labor

Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave (current servicemember).

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the Colorado Department of Labor and Employment or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.