Request for Unemployment and Wage Information:
This service is only available if you have previously filed an unemployment claim.  

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.

**Please allow 7-10 business days for return.**

For faster service please have the organization requesting this information send a request with a release form and the $5 fee payable to:  Connecticut Department of Labor.  This request should be mailed to the following address:

Connecticut Department of Labor

UI Special Programs Unit

200 Folly Brook Blvd

Wethersfield, CT 06109

See detailed instructions here.


* - 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   (###-##-####)

* 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     


  • Street Address  
  • City, State, Zip Code:   

I need proof of Unemployment for the last 6 months

I need my wage information for the past 12 months 


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.