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Additional Hearing Questionnaires

The Adjudications Division often requires additional forms to be submitted by parties to determine unemployment compensation eligibility.  Depending on the case, an Adjudications Specialist may request that you complete one of the forms listed below to render a decision. For questions on any of these forms, please call 860-754-5100

1. Statement of Late Filing (Form UC-LF) (PDF, 551KB) | Spanish (Formulario UC-LF S) (PDF, 478KB) 

2. Approved Training Questionnaire (Form UC-246)(PDF, 148KB) | Spanish (UC-246S) (PDF, 148KB)  

3. Claimant Severance/Vacation Questionnaire (Form IS-790SVC) (PDF, 126KB)

4. Corporate Officer Questionnaire (Form UC-2Q) (PDF, 131KB)

5. Dependency Allowance Questionnaire (Form UC-8Q) (PDF, 119KB)

6. Drug & Alcohol Testing Questionnaire (Form UC-843) (PDF, 347KB)

7. General Availability Questionnaire (Form UC-7Q) (PDF, 108KB) | Spanish UC-7Q S (PDF, 36KB)

8. Notice To Claimant Of Hearing (Form IS-790C) (PDF, 226KB) | Spanish (Formulario IS-790C) (PDF, 67KB)

9. Physician’s Certification of Claimant’s Health (Form UC-28) (PDF, 341KB)

10. Physician’s Statement - New Mothers (Form UC-792) (PDF, 86KB)

11. Quit To Escape Domestic Violence Questionnaire (Form UC-17Q) (PDF, 166KB)

12. Quit to Care For An Ill Relative Questionnaire (Form UC-6Q) (PDF, 228KB)

13. Quit For Medical Reasons Questionnaire (Form UC-5Q) (PDF, 92KB)

14. Refusal Of Work/Rehire Claimant Questionnaire (Form UC-13Q) (PDF, 161KB)

15. Refusal Of Work/Rehire Employer Questionnaire (Form UC-12Q) (PDF, 104KB)

16. Request for Physician’s Certification (Form UC-6Qa) (PDF, 134KB)

17. Request for Physician’s Certification for Part-time Availability (Form UC-27) (PDF, 377KB)

18. Self-Employment Questionnaire (Form UC-1Q) (PDF, 122KB)

19. Special Base Period: Workers’ Compensation Questionnaire Sick Leave - Disability Leave Questionnaire
(Form UC-11Q) (PDF, 259KB)

20.  31-227(d) Claimant Questionnaire  (Form IC-812CE) (PDF, 143KB)

21. Student Questionnaire (Form UC-3Q) (PDF, 68KB) 

22. Substance Abuse Information Sheet (Request for Certification by Substance Abuse Treatment Professional)
(FormUC-16Q) (PDF, 533KB)

23. Substance Abuse Information Sheet (Request for Recovery Efforts & Information) (Form UC-15Q) (PDF, 286KB)

24. Transportation Questionnaire (Form UC-4Q) (PDF, 50KB) 

25. Waiver Criteria (Form UC-2204) (PDF, 14KB)

26. Waiver Questionnaire (Form UC-2203) (PDF, 51KB)

27. Work Search Effort Form | Spanish 

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