Overpayment Assistance Form 2E

Overpayment Assistance Form
Have a question about an overpayment? Submit this form for assistance.

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Are you using a public computer? The overpayment form requests personal identifying information like your Social Security Number. Protect your information by closing the browser window when you are done. Log out of any of your accounts and use the ‘x’ in the top right corner of the window to shut the browser down.

Take your time filling out this form and be certain all of the information is complete and accurate.

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For general questions about an overpayment, see the Benefit Payment Control Unit FAQs. If you did not find an answer to your question, please complete the following form.

1. To make a payment online click here.

2. If you are mailing a payment:

Personal Checks or Money Orders - CTDOL accepts personal checks and money orders payable to:

Administrator Unemployment Compensation

Please include your name and the last four digits of your Social Security Number on your check or money order. Processing may take 7-10 business days.

Mail to:
Connecticut Department of Labor
Post Office Box 30290
Hartford, Connecticut 06150-0290

3. To file an appeal, click here.

If you need to submit a question to Benefit Payment Control, please agree to the terms below by checking "I accept." Once this step is complete, you will be able to submit your question.
- I certify that I am the claimant indicated below.
- I understand that the law provides penalties for making false statements, or any other misrepresentation, for the purpose of obtaining unemployment benefits.
* - Indicates required data
Do you accept these terms:*

I ACCEPT

Date of Submittal

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Name:*

First NameLast Name
Claimant Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Last Four Digits of Social Security Number:*
Date of Birth (for security reasons):*

MonthDayYear
Date
Email Address:*
example@example.com
Phone Number (including Area Code):*
Please enter a valid phone number.
Mother's Maiden Name:*
Below you will have an opportunity to request information by either asking for a phone call or receiving information via email.

Please select the option you prefer. Please be advised that we cannot address any questions regarding the intercept of federal tax refunds by email.

If you have a question regarding the intercept of federal taxes to repay an overpayment, please select the option for a call back.
* Please note that only one option can be selected below.
Option #1
If you have questions regarding how to make a voluntary payment, your overpayment balance, payments we have received, weeks you have on hold due to a monetary penalty from a fraudulent overpayment, interest, mandatory repayment schedules, notices of non-compliance, repayment plans, bankruptcy and collection of overpayments including offsets of benefits, garnishments, and intercepts of tax refunds (select phone call option to discuss intercepts):

Please check this box
I would like to receive a phone call:

Please check box if this is your preferred method of contact.
I would like to receive an email:

Please check box if this is your preferred method of contact.
Option #2
If you have questions regarding the status ofyour Overpayment Predetermination Notice response (including waiver requests when applicable), the status of your appeal request, question about your return-to-work letter and weeks on hold or to report wages that you did not report when you filed for your weekly benefits and status of overpayment you requested be created:

Please check this box
I would like to receive a phone call:

Please check box if this is your preferred method of contact.
I would like to receive an email:

Please check box if this is your preferred method of contact.
Please verify that you are not a robot*
Should be Empty: