Report Unauthorized Change

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The form below requires confidential information. Therefore, it is vital for you to close your browser completely after submitting this form. This will prevent others from accessing the information you have entered. To close your browser, click the "x" in the top right-hand corner of the browser window.
IMPORTANT NOTE: Verify you completed the form and all information is accurate and matches your filed claim before you submit it.

You have accessed this page because you received a notice stating that you accessed or changed your ReEmployCT unemployment benefits payment method, mailing address, email address, or password and you are certifying that you did not authorize this change.

* - 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. 


* 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: (to contact you only for confirmation)  

Contact Phone    

Based on the notice I received, I am reporting that (select any that apply): 

I did not change my ReEmployCT unemployment benefits payment method.

I did not change my mailing address on my ReEmployCT unemployment benefits account.

I did not change the password on my ReEmployCT unemployment benefits account.

I did not change my email address on my ReEmployCT.

I did not create a ReEmployCT unemployment benefits account.


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.