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.

“*” indicates a required field

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This Jotform should be used if you have questions regarding overpayments. After submitting this form, a representative from the Benefit Payment Control Unit will contact you. Please note that we cannot discuss the intercept of IRS tax refunds via email. Please request a call back if you require information about an IRS tax refund intercept. Please visit our Frequently Asked Questions for additional information regarding overpayments.

1. To make a payment online visit the Official Payments website.

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

Do not mail or bring payments to 200 Folly Brook Blvd in Wethersfield, as it will cause significant delays in processing your payment.

3. To file an appeal, visit the Unemployment Appeals website.

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.
Do you accept these terms:
- Date of Submittal
  
  MonthDayYear
- 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
- Email Address:
  example@example.com
- Phone Number (including Area Code):
  
  Area CodePhone 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.
- I would like to receive a phone call:
- I would like to receive an email:
- 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):
- I would like to receive a phone call:
- I would like to receive an email:
- 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:
- I would like to receive a phone call:
- I would like to receive an email:
- Please verify that you are not a robot
- Please draw image for verification:
- Should be Empty: