ADVISEMENT 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 the 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.
You have indicated you updated your banking
information and are requesting that your unemployment compensation
payments be reissued. Please complete the form below.
Before submitting this form, please
verify that all required information is fully completed and that the
information matches what you provided to the Department of Labor
when you originally filed your claim.
* - Denotes
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.
* Full Name:
(format = ######### - no dashes please)
* Mother's Maiden Name (for
* Date of Birth (for
Email Address: (to contact you
only for confirmation)
Contact Phone (including area code):
By submitting this form you are informing us that you have updated
your banking information and are requesting your payment(s) to be