EOLWD-DFML

Did you receive a 1099-G from DFML even though you never filed for PFML benefits?(Required)

Yes

For what tax year did you receive the at-issue 1099-G from DFML?(Required)

2022

2023

2024

2025

Did you receive any other communications from DFML about PFML benefits?(Required)

Yes

Please give us more details about the fraud you are reporting.(Required)

Name(Required)

First Name Last Name

Month of Birth(Required)

Day of Birth(Required)

Please enter a number from 1 to 31.

Phone number(Required)

Email address(Required)

Enter Email Confirm Email

Address(Required)

Address Line 1 Address Line 2 City State ZIP Code

Employer Name(Required)

Employer FEIN (Federal Employer Identification Number)