Additional Hearing Questionnaires

Additional hearing questionnaires

The Adjudications Division often requires additional forms to be submitted by parties to determine unemployment compensation eligibility.  Depending on the case, an Adjudications Specialist may request that you complete one of the forms listed below to render a decision.

For questions on any of these forms, please call the Adjudications Division at (860) 754-5100

Physician's Certification for Quit to Care for an Ill Relative

Form UC-6QA

Physician's Certification for Quit to Care for an Ill Relative
Family Icon

Form UC-6Q

Quit to Care for an Ill Relative Questionnaire
Substance Abuse Information Sheet (Request for Recovery Efforts & Information)

Form UC-15Q

Substance Abuse Information Sheet (Request for Recovery Efforts & Information)
Substance Abuse Information Sheet (Request for Certification by Substance Abuse Treatment Professional)

Form UC-16Q

Substance Abuse Information Sheet (Request for Certification by Substance Abuse Treatment Professional)
Request for Physician’s Certification for Part-time Availability

Form UC-27

Request for Physician’s Certification for Part-time Availability
icon

Form UC-28

Physician’s Certification of Claimant’s Health
Drug & Alcohol Testing Questionnaire

Form UC-843

Drug and Alcohol Testing Questionnaire
Waiver Questionnaire

Form UC-2203

Waiver Questionnaire
Waiver Criteria

Form UC-2204

Waiver Criteria

Contact Information and Location