Additional Hearing Questionnaires

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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. 

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Form UC-6QA
Physician's Certification for Quit to Care for an Ill Relative
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Form UC-6Q
Quit to Care for an Ill Relative Questionnaire
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Form UC-15Q
Substance Abuse Information Sheet (Request for Recovery Efforts & Information)
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Form UC-16Q
Substance Abuse Information Sheet (Request for Certification by Substance Abuse Treatment Professional)
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Form UC-27
Request for Physician’s Certification for Part-time Availability
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Form UC-28
Physician’s Certification of Claimant’s Health
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Form UC-843
Drug and Alcohol Testing Questionnaire
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Form UC-2203
Waiver Questionnaire
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Form UC-2204
Waiver Criteria

Contact Information and Location