CTDOL Non-Unemployment Benefits Help Request Form

CTDOL Non-Unemployment Benefits Help Request Form
REASONS/ISSUE *
To report an unauthorized change, please fill out this form:
https://www.ctdol.state.ct.us/UI-Help/UI-Help-sec/reportunauthorizedchange.htm
For questions about the Paid FMLA please visit: www.ctpaidleave.org
THIS FORM IS NOT FOR CLAIMS OR ADJUDICATIONS QUESTIONS.

Please do not submit this form for claims or adjudications questions. Instead, visit the consumer contact center at www.FileCTUI.com for our customer service phone numbers or submit a question through Ask DOL on the bottom of that page.
*THIS IS NOT a claims or adjudications question* *

Please check box to confirm
Please enter broken web link: *
If you have a question regarding an overpayment or repayment of benefits please fill out this form:
https://www.ctdol.state.ct.us/UI-Help/UI-Help-sec/overpaymentassistance.htm
Full Name: *

First Name Last Name
Date of Birth (for verification purposes): *

Month Day Year
Email *
example@example.com
Phone Number *

Area Code Phone Number
Town *
Please describe how we can help you: *
Please verify that you are human *
Should be Empty: