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 2020 calendar year, please complete this report.

CLAIMANT INFORMATION

First Name *

Last Name *

SSN (Last 4 Digits ONLY) *

Phone *

Email *

Date of Birth *

Day Day12345678910111213141516171819202122232425262728293031

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Year Year1871187218731874187518761877187818791880188118821883188418851886188718881889189018911892189318941895189618971898189919001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021

---

1099 INFORMATION

Which 1099-G forms did you receive (select all that apply) *

001-UI

002-PUA

003-LWA

004-VSTS

005-TREAS

The 1099 description can be found in the "Account Number" section at the bottom left of the document.

---

DOC UPLOAD

Upload any relevant documentation pertaining to this case.

---

CERTIFICATION *

I certify that I did not file for unemployment insurance benefits through the State of Vermont during the 2020 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.