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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,
If your question could not be answered please complete the form
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Check or Money Order payable to:
Administrator Unemployment Compensation
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
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:
* Mother's Maiden Name (for
* Date of Birth (for
Contact Phone (including area code):
* Please check
all that apply:
What is my overpayment and/or monetary
When was my last payment applied to my
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
(If yes, please enter amount)
(please choose one)
Questions (i.e: Did you receive my paperwork?, I received a
Predetermination Letter, etc..)