Request for Telephone Hearing

  • A case number is required to request telephone participation.
  • This form is for changing your method of participation in a scheduled appeals hearing only. Any other submissions or inquiries sent using this form will not receive a response.
  • Requests should be submitted as far in advance of the hearing as possible.
  • If you have any documents or written materials you want the Referee to consider at the hearing FAX them immediately to the Referee at (860) 754-5059 (if scheduled in Middletown) or (203) 437-3440 (if scheduled in Waterbury). Copies should be mailed to the other parties at the address(es) shown on the hearing notice. 

* - Denotes required field

Case Information
*Case Number 
*Hearing Date
*Hearing Time 
*Referee   (Found on Page 2 of Hearing Notice)
                       Party Information
*Title (Claimant/Employer/
On Behalf Of
*Return Email Address


*Reason for Telephone Request. Date and time of hearing will not change.


I understand that I must immediately FAX any documents or written materials I want the Referee to consider at the hearing to 860-754-5059 (if scheduled in Middletown) or 203-437-3440 (if scheduled in Waterbury) and must mail copies to the other parties at the address(es) shown on the hearing notice.


I understand it is my responsibility to call the Appeals Division at 860-754-5020 (if scheduled in Middletown) or 866-291-3921 (if scheduled in Waterbury) fifteen (15) minutes before the hearing and provide a number for the Referee to contact me. The Appeals Division will NOT call me unless I first register my appearance. I understand that I may lose the appeal if I fail to call in as instructed and participate in the hearing.



VERY IMPORTANT NOTE: If the form instructs you to make changes AFTER pressing the "Submit" button, return to the form by pressing the "Back" button on your computer. This will retain the information you've already entered. If you press the "Return to the Form" link at the bottom of the page, you will lose all of the information you've previously entered.

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