Submit a Claim - Instruction & Login

If you are a Settlement Class Member, you are eligible to make a claim for:

  1. One or more of the following benefits:

    • Attested Time Spent – Reimbursement for up to 10 hours of lost time at a rate of $30 per hour for time spent remedying issues related to the Data Incident; and/or

    • Documented Ordinary Losses – Up to $1,500 for documented unreimbursed out-of-pocket expenses fairly traceable to the Data Incident; and/or

    • Documented Extraordinary Losses – Compensation for extraordinary losses resulting from the Data Incident, up to $10,000.

    OR

  2. Alternative Cash Payment – As an alternative to filing a Claim Form for reimbursement of Ordinary Losses, Attested Time Spent, or Extraordinary Losses, you may submit a Claim Form to receive a pro rata payment from the net Settlement Fund, which is $2,450,000 minus payment of costs of the Settlement including the costs of the Notice Program and Claims Administration, Attorneys’ Fees and Expenses of up to $661,500, Service Awards of up to $1,500 each to the Representative Plaintiffs, and payments for claims for Ordinary Losses, Attested Time Spent, and Extraordinary Losses.

Complete information about the Settlement and Settlement Benefits are available in the Notice and on the Frequently Asked Questions (FAQs) page of this website.

Claim Forms must be submitted online or postmarked (if mailed) no later than June 19, 2024. Claims submitted after the deadline will be deemed untimely and may not be accepted.


Documentation:

If you plan to make a claim for reimbursement of out-of-pocket expenses, documentation must be provided to support your claim. Documents should be clear, readable copies, as anything you submit will not be returned to you. You may redact unrelated transactions and all but the first four and last four digits of any account number (if applicable). See the table below for examples of sufficient documentation for expense types.

Expense Type Examples of Documentation Required
Unreimbursed Bank Fees Examples: Bank statements with fees, such as card reissuance, unreimbursed overdraft and late fees.
Long Distance Phone Charges Examples: Phone bills with charges.
Unreimbursed Credit Card Fees Examples: Credit card statement.
Unreimbursed Credit Monitoring Examples: Costs of credit report(s), credit monitoring, and/or other identity theft insurance products purchased.
Other Losses or Costs Resulting from Identity Theft or Fraud Examples: Include but not limited to, the cost of postage, gas for local travel or interest on payday loans due to card cancellation
Extraordinary Loss Examples: Professional fees incurred to address identity theft or fraud, such as falsified tax returns, account fraud, and/or medical identity theft.
Other Extraordinary Losses Please provide a detailed description or a separate document submitted with this Claim Form.

If you are filing online, please have this information ready before you start to file, as your claim will not be saved if you have to come back and finish at a later time. Documents that are uploaded must be less than 20 MB per file and in one of these formats: jpg, jpeg, png, gif, tif, tiff, doc, docx, xls, xlsx, pdf, txt, rtf, or zip. If you are unable to electronically upload a copy of your documents as part of the online Claim Form, you will need to mail a printed Claim Form along with your documentation to the Claims Administrator.

Please Note: The Claims Administrator may contact you to request additional documents to process your claim. Settlement benefits will be distributed after the Settlement Agreement is approved by the Court and becomes Final. Your cash payment may decrease depending on the number of claims filed.


File a Claim Online:

Before Claim Filing: You will need the Unique ID printed on the Notice that you received in the mail. If you did not receive a Notice or have lost yours, please contact the Claims Administrator at info@ConvergentDataBreachSettlement.com for assistance.

During Claim Filing: As part of filling out your Claim Form, you will be asked to verify information associated with the losses claimed. You must also submit all required supporting documentation. Documents supporting your claim could include credit card statements, bank statements, invoices, telephone records, and receipts. Documented Loss costs cannot be documented solely by a personal certification, declaration, or affidavit from you. Supporting documentation should be clear, readable copies, as they will not be returned to you. Please keep copies of everything you submit, as your claim may be audited, and you could be asked to provide additional information to process the claim.

After Claim Filing: After submitting your completed claim online, you will receive an email with a confirmation code for your completed submission. Be sure to keep your confirmation email and code and refer back to them if you have any questions about your Claim Form. If additional information is required to complete your claim, you will be contacted by the Claims Administrator.

To submit an online Claim Form please enter your Unique ID and PIN below and select “Login.”

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Where can I find my Login information?

File a Claim by Mail:

As part of your Notice, you were sent a Claim Form. You may also download a copy of the Claim Form here. Read the instructions carefully, fill out the form, sign it, then mail it so that is it postmarked by June 19, 2024, and send it to the following address:

COI Claims Administrator
P.O. Box 5526
Portland, OR 97228-5526

Remember: All Claim Forms must be submitted online or postmarked no later than June 19, 2024.