unemployment ONLINE aSSISTANCE CENTER
Address Change Request

EXTREMELY IMPORTANT NOTE REGARDING THE ENTRY OF CONFIDENTIAL INFORMATION:
This form requires the entry of confidential information. Therefore, it is extremely important for you to close down your browser completely after submitting this form. This will prevent others from accessing the information you have entered. To close down your browser, click the "x" in the top right-hand corner of the browser window.
 
IMPORTANT NOTE: Before submitting this form please verify that all required information is fully completed and that all information matches what you would have provided to the Department of Labor when you originally filed your claim.
 

You have indicated your address has changed.  Please complete the form below to change your address.

* - Denotes required field

I certify that I am the claimant indicated below.  I understand that the law provides penalties for making false statements or any misrepresentation to obtain unemployment benefits. 

*I AGREE
 


* Full Name  

* SSN   (###-##-####)

* Mother's Maiden Name (for verification purposes):   

* Date of Birth (for verification purposes):    (MM/DD/YYYY)

Email Address: (to contact you only for confirmation)  

Contact Phone    

* FORMER ADDRESS: 

  • Former Street Address  
     
  • Former City, State, Zip Code:   

* NEW ADDRESS:

  • New Street Address:   
     
  • New City, State, Zip Code:   

  

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.