Penalty Waiver Request Form

For Vermont Unemployment Insurance Wage Reporting  

For consideration, Employers shall complete this form, verify its contents, and submit to the Vermont Department of Labor. 

Please allow thirty (30) days from the date of receipt for review. This waiver request does not exempt employers from the requirement to file quarterly wage reports, respond to separation forms, or respond to wage requests. 

ex. 123 Main Street, North Town, Vermont 01234

Contact Information

COVID-19 Update: Department of Labor offices are currently closed due to COVID-19. Please contact the Department by phone.

Vermont Department of Labor
5 Green Mountain Drive
P.O. Box 488
Montpelier, 05601-0488
(802) 828-4000

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