EXTREMELY IMPORTANT NOTE REGARDING THE ENTRY OF
CONFIDENTIAL INFORMATION:
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.
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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.
*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: (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. |
