Connecticut Department of Labor 1099G Request Form

Connecticut Department of Labor 1099G Request Form
If you complete this request, we will mail you a 1099G form. Please be advised that due to the high level of claims being filed there will be a substantial delay to process this request.

EXTREMELY IMPORTANT NOTE REGARDING THE ENTRY OF CONFIDENTIAL INFORMATION:

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 verify that your contact information is up to date in your ReEmployCT account before submitting this form.

If you are trying to notify the Labor Department that you did not file a claim for benefits and should not have received a 1099G, please click here.
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:*

First NameLast Name
Social Security Number:*
(format = ######### - no dashes please)
Date of Birth (for verification purposes):*

MonthDayYear
(MM/DD/YYYY)
Email Address: (to contact you only for confirmation) *
example@example.com
Contact Phone:*
Please enter a valid phone number.
Tax Year(s) Being Requested:

2021202020192018201720162015
Check here if you received PUA benefits in any of the tax years being requested:
Current Mailing Address:*

Current Street Address

Current Street Address Line 2

Current CityCurrent State / Province

Current Postal / Zip Code
Mailing Address When You Filed for Benefits, if Different

Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: