unemployment ONLINE aSSISTANCE CENTER
Income Tax Withholding Status Change

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 indicated that you would like to CHANGE your income tax withholding status.  To facilitate this request, please answer the following questions and a representative will complete your request the next business day.

* - 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    

* Select tax withholding status you would like:    Yes - Withhold      No - Do NOT Withhold
 

  

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.