Form Uc-60 - Authorization Of Release Of Wage And Pension Information

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UC-60 (Rev. 3/14)
(For Office use Only)
IMPORTANTE – TENGA ESTO TRADUCIDO
INMEDIATAMENTE
CONNECTICUT DEPARTMENT OF LABOR
CLAIMS EXAMINATION UNIT
200 FOLLY BROOK BOULEVARD
WETHERSFIELD CT 06109-1114 TELEPHONE (860) 263-6635
GENERAL RELEASE
If instructed to do so by the call Center Service Representative:
Please complete and return
this form to the above address.
Fill out all of the information requested to the right
and sign this document below. It is extremely
NAME:________________________________________
important that all of the requested information is
First
M.I.
Last
provided and that your signature is on this release
SOC. SEC. NO.:__ __ __ / __ __ / __ __ __ __
form. Failure to do so could cause a serious delay
in the processing of your claim for benefits.
AUTHORIZATION OF RELEASE OF WAGE AND PENSION INFORMATION
I authorize the release to the Connecticut Department of Labor of such pension and other income information
that may be required to determine my eligibility for unemployment compensation benefits.
CLAIMANT=S SIGNATURE REQUIRED: ____________________________________________________
Information concerning an individual=s unemployment compensation claim may be disclosed, under
certain circumstances, to other governmental agencies pursuant to Title XI of the Social Security Act
as amended by Public Law 98-369 (42 U.S.C. 503 (F) ). It is possible that information concerning
your filing history could be accessed by other state, municipal, or federal agencies involved in an
income and eligibility verification system.
AUTHORITY: The Connecticut State Labor Department, Employment Security Division is empowered
to solicit information to access wage records and process your application or claim for benefits
under the authority of Connecticut Statute, Sections 31-222 and 31-254 as supplemented by Section

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