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.
|
For general overpayment questions,
please see
BPCU FAQ's.
If your question could not be answered please complete the form
below.
- To make an Online Payment click
here.
Check or Money Order payable to:
Administrator Unemployment Compensation
Mail to:
Connecticut Department of Labor
Post Office Box 30290
Hartford, Connecticut 06150-0290
(Please allow 7-10 business days for processing)
If you need additional assistance
please complete the form below.
* - 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
(format = ######### - no dashes please)
* Mother's Maiden Name (for
verification purposes):
* Date of Birth (for
verification purposes):
(MM/DD/YYYY)
*
Email Address:
Contact Phone (including area code):
* Please check
all that apply:
What is my overpayment and/or monetary
penalty balance?
When was my last payment applied to my
overpayment balance?
I would like to report an overpayment of
unemployment benefits I received. Please include hours worked,
gross wages, dates of employment, and employers name and address.
I would like to set up or modify an existing
payment arrangement.
(If yes, please enter amount)
Amount:
Weekly
Monthly
(please choose one)
Start Date:
General
Questions (i.e: Did you receive my paperwork?, I received a
Predetermination Letter, etc..)
|
