Request Corrected 1099-G

If you are needing information on your Department of Labor 1099-G to be corrected, please complete this form.

Note: A misspelled name or incorrect address do not require a corrected 1099-G. Only if the name and/or social security number does to match your own, or if you believe the benefit amount or tax withholdings are incorrect, do you need to submit this form.

Claimant Information

First Name

Last Name

SSN (Last 4 Digits ONLY)

Phone Number

Date of Birth

Request for Correction

Unemployment Insurance 1099

001-UI

What needs to be corrected on your UI 1099-G? (Responses limited to 150 characters)

Pandemic Unemployment Assistance 1099

002-PUA

What needs to be corrected on your PUA 1099-G? (Responses limited to 150 characters)

Lost Wages Assistance 1099

003-LWA

What needs to be corrected on your LWA 1099-G? (Responses limited to 150 characters)

Address Section

Street or P.O. Box

City

State

Zip

Additional Information

Please note that benefit amounts are calculated by the Vermont Department of Labor's payment database. The Department works to keep an accurate accounting of benefits received for each claimant. Remember that amounts can include additional federal benefits, as well as any taxes withheld at the claimant's request.

If you believe there is a discrepancy, please upload any documentation in the field below as proof you received a different amount. Failure to upload documentation will result in the Department reviewing ONLY internal payment records to validate benefit amounts.

Doc Upload (Optional)

One file only.
2 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Certification

I certify that I am the claimant represented by the information provided above or that I have permission from the claimant to submit this request on their behalf.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.