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State of Vermont
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Report Fraud Related to 1099-G
If you recevied a 1099 from the Department of Labor but never filed for, or received, unemployment benefits during the 2021 calendar year, please complete this report.
SSN (Last 4 Digits ONLY)
Date of Birth
Which 1099-G forms did you receive (select all that apply)
Upload any relevant documentation pertaining to this case.
One file only.
2 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.
I certify that I did not file for unemployment insurance benefits through the State of Vermont during the 2021 calendar year. Any claim that was opened and/or paid in my name should be considered fraudulent. Furthermore, I understand that falsely obtaining benefits is a crime and subject to prosecution.
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