If you received a personalized notice in the mail or via email with a Notice ID and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Notice ID exactly as it appears on your personalized Notice, (i.e. 12345678).

If you did not receive a personalized Notice in the mail or via email, click below to complete a Claim Form.

The deadline for submitting this proof of claim form is

Contact Information

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Payment Eligibility Information

Please review the notice and section IV of the Settlement Agreement (available at www.Aspenpointesettlement.com) for more information on who is eligible for a payment and the nature of the expenses or losses that can be claimed.

Please provide as much information as you can to help us figure out if you are entitled to a settlement payment.

PLEASE PROVIDE THE INFORMATION LISTED BELOW:

Check the box for each category of benefits you would like to claim. Categories include reimbursement of out-of-pocket expenses and lost time spent as a result of the Data Incident (up to a maximum of $500.00), reimbursement of extraordinary expenses incurred as a result of the Data Incident (up to a maximum of $4,500), and up to 24-months of credit monitoring and identity protection services to be paid for by Defendant. Please be sure to fill in the total amount you are claiming for each category and to attach documentation of the charges as described in bold type (if you are asked to provide account statements as part of proof required for any part of your claim, you may mark out any unrelated transactions, account numbers, or personal information (other than name) if you wish).

a. Ordinary Out-of-Pocket Expenses Resulting from the Data Breach

Examples - unreimbursed losses relating to fraud or identity theft; professional fees including attorneys’ fees, accountants’ fees and fees for credit repair services; costs associated with freezing or unfreezing credit with any credit reporting agency; credit monitoring costs that were incurred on or after November 19, 2020 through October 18,2022; and miscellaneous expenses such as notary, fax, postage, copying, mileage, long-distance telephone charges, and data charges (only if charged based on the amount of data used) that were incurred on or after September 12, 2020, through October 18,2022.

Documentation of out-of-pocket expenses is required.

If you are seeking reimbursement for fees, expenses, or charges, you MUST attach a copy of a statement from the company that charged you, or a receipt for the amount you incurred.

If you are seeking reimbursement for credit reports, credit monitoring, or other identity theft insurance product purchased between November 19, 2020, through October 18,2022, you MUST attach a copy of a receipt or other proof of purchase for each credit report or product purchased. (Note: By claiming reimbursement in this category, you certify that you purchased the credit monitoring or identity theft insurance product because of the Data Breach and not for any other purpose).

Supporting documentation must be provided. You may mark out any transactions, account numbers, or personal information (other than name) that are not relevant to your claim before sending in the documentation.

b. Extraordinary Expenses Resulting from the Data Breach

Documentation of the extraordinary loss is REQUIRED. The loss must be an actual, documented, and unreimbursed monetary loss, fairly traceable to the Data Breach, must have occurred between September 12, 2020, and the October 18, 2022, and must not already be covered by the ordinary reimbursement category.

You may mark out any transactions, account numbers, or personal information (other than name) that are not relevant to your claim before sending in the documentation.

c. Between one and four hours of documented time spent dealing with the Data Breach

Examples – You spent at least one full hour calling customer service lines, writing letters or emails, or on the Internet in order to get fraudulent charges reversed or in updating automatic payment programs because of the Data Breach. You spent at least one full hour rescheduling medical appointments and/or finding alternative medical care and treatment, retaking or submitting to medical tests, locating medical records, retracing medical history as a result of the Data Incident.

d. Claim up to 24-months of credit monitoring and identity protection services

The Settlement requires Defendant to provide up to 24-months of credit monitoring and identity protection services for Settlement Class Members that submit timely and valid claims.

Supporting Documentation

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected.

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    Payment Method

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    Sign And Date Your Claim Form

    I declare under penalty of perjury under the laws of the United States, the laws of Colorado, and the laws of my State of residence that the information supplied in this claim form by the undersigned is true and correct, and that this form was executed on the date set forth below.

    I understand that I may be asked to provide supplemental information by the Settlement Administrator before my claim will be considered complete and valid.

    Your Claim Form has been submitted successfully.

    Please print this page for your records.

    Your Claim Details
    Submitted Claim ID:
    Confirmation Code:
    You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
    CLAIM INFORMATION
    First Name
    Last Name
    Street Address
    Street Address 2
    City
    State
    Zip Code
    Email Address
    Phone Number
    Signature
    Date

    If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@AspenPointeSettlement.com

    Click here to edit your Claim.

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