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VERY IMPORTANT NOTE: Before submitting this form, please verify that all required information is fully completed, and that said information matches what you submitted to the Department of Labor at the beginning of your claim.
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For general questions about
an overpayment, see the Benefit
Payment Control Unit FAQs . If you did
not find an answer to your question, please complete the following
form.
Mail to:
Connecticut Department of Labor
Post Office Box 30290
Hartford, Connecticut 06150-0290
(Processing may take 7-10
business days)
If you need further assistance, please complete the form below.
* - Indicates
required data
I certify that I am the
claimant indicated below.
I understand that the law
provides penalties for making false statements, or any other
misrepresentation, for the purpose of obtaining unemployment
benefits.
*I
ACCEPT
*
Full name:
*
Social Security Number:
(#########)
*
Mother's Maiden Name (for security reasons):
*
Date of birth (for security
reasons):
(MM/DD/YYYY)
*
Email address:
Telephone number (including
area code) :
*
Please check all fields that
apply:
What is my overpayment and/or
my monetary penalty balance?
When was my
last payment applied to my overpaid balance?
I would like to report an
overpayment of unemployment benefits that I received. Please
include hours worked, gross earnings, dates of employment, and
employer name and address.
I
would like to establish or modify an existing payment agreement.
Amount:
Weekly
Monthly
Start Date:
General
Questions (ie: Did you get my information? Did I get a
predetermination letter, etc.)
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