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Additional Hearing Questionnaires

The Adjudications Division often requires additional forms to be submitted by parties to determine unemployment compensation eligibility.  Depending on the case, an Adjudications Specialist may request that you complete one of the forms listed below to render a decision. For questions on any of these forms, please call 860-754-5100. 

1. Physician's Certification for Quit to Care for an Ill Relative (Form UC-6Qa) (PDF) 

2. Quit to Care For An Ill Relative Questionnaire (Form UC-6Q) (PDF)

3. Substance Abuse Information Sheet (Request for Recovery Efforts & Information) (Form UC-15Q) (PDF) 

4. Substance Abuse Information Sheet (Request for Certification by Substance Abuse Treatment Professional)
   (Form UC-16Q) (PDF)

5. Request for Physician’s Certification for Part-time Availability (Form UC-27) (PDF)

6. Physician’s Certification of Claimant’s Health (Form UC-28) (PDF)  

7. Drug & Alcohol Testing Questionnaire (Form UC-843) (PDF)   

8. Waiver Questionnaire (Form UC-2203) (PDF)

9. Waiver Criteria (Form UC-2204) (PDF)  

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