Request New or Duplicate 1099-G

If you are in need of a new 1099-G from the Department of Labor either because you need a copy or never received a 1099-G, please complete this form.

CLAIMANT INFORMATION

First Name *

Last Name *

SSN (Last 4 Digits ONLY) *

Phone *

Email *

Date of Birth *

Day Day12345678910111213141516171819202122232425262728293031

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Year Year1871187218731874187518761877187818791880188118821883188418851886188718881889189018911892189318941895189618971898189919001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021

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REQUEST FOR DUPLICATE 1099(s)

Reason for Request *

Copy/Duplicate

Never Received

Select the 1099-G form(s) for which you are requesting *

001-UI: Unemployment Insurance (UI) benefits received in 2020, including extended benefit weeks, and the additional $600 per week under the FPUC program.

002-PUA: Pandemic Unemployment Assistance (PUA) benefits received in 2020, including the additional $600 per week under the FPUC program.

003-LWA: Lost Wage Assistance (LWA) benefits received in 2020. This federal program provided an additional $300 per week to eligible claimants between August 1 and September 5.

004-VSTS: Vermont Short Term Supplemental (VSTS) benefits received in 2020. This state benefit provided an additional $100 per week to claimants between September 27 and October 31.

005-TREAS: One-time payment of $1,200 issued by the State on April 20. This was for Vermonters who had filed for unemployment insurance benefits between March 15 and April 4 but had not yet received any benefit payments.

All that I am eligible for.

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MAILING ADDRESS

Please provide the mailing address where you would like your new document sent.

Street or P.O Box *

City *

State *

Zip Code *

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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.