Request Replacement 1099-G

This questionnaire is for claimants to request a replacement 1099 tax form for regular unemployment insurance benefits received in 2020. Complete this questionnaire only if you need to request a copy of your 1099 tax form.

Please note that if you received Pandemic Unemployment Assistance (PUA) benefits in 2020, you can find your 1099 form by logging into MyUI+.

If you received a 1099 form but it is inaccurate, or if you received a 1099 form but never filed for unemployment insurance benefits in 2020, you will need to complete this questionnaire instead.

* Required

Your Information

In order for us to send you a copy of your 1099, we need you to provide correct and complete information in the form. Read the instructions and fields carefully.

Your Date of Birth

Your Social Security Number

Please provide your social security number (SSN). Reread the number you enter and make sure it is correct. This form is being completed on a secure site connected to MyUI+. We need your SSN in order to locate your unemployment claim. You must put the entire SSN in this field in order for us to send you a replacement 1099.

Please Confirm Your Social Security Number

The SSN entered in this field must match what you entered above. If your SSN does not match what was entered above, you will receive an error message, and you will not be able to proceed until both fields match. Reread the number you enter and make sure it is correct.

SSN Match

Has your address changed?

YesNo

Requestor Address Information

Please be careful when entering your address below, and only enter the information asked for (only put your house number in the 'house number' box, only put your zip code in the 'zip code' box, etc.)

When we mail out any replacement 1099, it will go to the address you enter below. Make sure to provide a current, correct address at which you would like to receive your 1099. If you enter anything other than address information in these boxes, we will not be able to supply you with a replacement 1099 form.

Your First Name

Your Last Name

Your House Number

Or type 'PO Box' if your mailing address is a post office box.

Your Street Name

Or your PO Box number if your mailing address is a post office box.

Your Apartment or Suite Number (Optional)

City

State

Zip Code

Do you receive mail under your name at this address?

YesNo

Whose name should we send any correspondence to?

(This name will appear in addition to your name on any correspondence mailed.)

Please confirm this statement by checking the box below.

I certify that I have answered the questions in this form truthfully. I understand that there are penalties for providing false or misleading information.

Yes, I agree

Contact Information