Benefit Payment Control Unit Employer Contact Form

Benefit Payment Control Unit Employer Contact Form
If you are an employer who has received a request from Benefit Payment Control and you have questions about the request, please use this Jotform to submit your question. We will respond to your inquiry as soon as possible. By submitting this request, you are certifying that you are an agent of the employer. Please do not send completed wage information or requests via this Jotform. Please mail completed requests to:

Benefit Payment Control Unit
Connecticut Department of Labor
200 Folly Brook Blvd.
Wethersfield, CT 06109

Or

Fax them to: 860-263-6343

*** PLEASE NOTE - BY PROVIDING TIMELY, COMPLETE AND ACCURATE WAGE INFORMATION TO CTDOL, YOU HELP PROTECT THE INTEGRITY OF THE UNEMPLOYMENT INSURANCE SYSTEM. WE APPRECIATE YOUR COOPERATION IN THIS PARTNERSHIP. ***
Full Name:*

First NameLast Name
Title of Person Completing the Form:*
Phone Number:*
Please enter a valid phone number.
Phone Extension Number (if applicable):
Email:*
example@example.com
Name of Company Where Request Was Sent:*
Last Name of Employee for Inquiry:*
Last Four of Employee’s SSN for Inquiry:*
Date of Request:*

MonthDayYear
Date
What is Your Question?:*
Should be Empty: