Section B - Preparing To File Your Tele-Benefits Claim
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3STATE OF CONNECTICUT - DEPARTMENT OF LABOR
SECTION B - PREPARING TO FILE YOUR TELE-BENEFITS CLAIM
When you call to file your claim you will be asked for your Social Security number and be given instructions to create your own
four-digit PIN (Personal Identification Number). Your PIN protects the privacy of your claim and has the SAME LEGAL
AUTHORITY AS YOUR SIGNATURE ON A PAPER. Select a PIN you will easily remember because you will use it whenever
you file a claim. Do not give your PIN to anyone.
The questions listed below, and any follow-up questions indicated, will be asked when you call to file your
new claim. It will speed the processing of your claim if you answer the questions BEFORE calling.
(1) Yes
(2) No
1. Have you worked or filed a claim in a state other than Connecticut in the last
24 months? (If Yes, disregard remaining questions and go to Question 1 in
SECTION C, page 3)
(1) Yes
(2) No
2. Are you currently working full time?
(_______) - _______ - __________
3. What is your telephone number? (Including area code)
4. What is your date of birth?
(Example: 07/22/1972)
__ __ / __ __ / __ __ __ __
5. What is your sex?
1. Male
2. Female
6. What is your marital status?
1. Single
2. Married
3. Widowed
4. Separated
5. Divorced
7. What is your race?
1. White
2. African American
3. Hispanic
4. Native American
(for statistical purposes only)
5. Asian
6. Other (check #6 if none of the above or you choose not to answer)
(1) Yes
(2) No
8. Are you a United States citizen?
(If No, write your Alien # here)
Please have your Alien card available prior to calling the Tele-Benefits line.
(1) Yes
(2) No
9. Are you available for full time work?
(1) Yes
(2) No
10. Are you attending school or in a training program? (If Yes, complete Question
10 in SECTION C, page 3)
11. Did you collect Worker’s Compensation or were you on an approved
(1) Yes
(2) No
medical leave in the last 24 months? (If Yes, complete Question 11 in SECTION
C, page 3)
(1) Yes
(2) No
12. Are you self-employed? (Answer yes whether or not you are currently receiving
income from self-employment)
13. Are you or have you been an officer of a corporation in the last 24 months?
(1) Yes
(2) No
14. Are you receiving primary Social Security benefits based on your own
(1) Yes
(2) No
earnings? (If Yes, complete Question 14 in SECTION C, page 3)
15. Are you receiving a pension? ( If Yes, complete Question 15 in SECTION C,
(1) Yes
(2) No
page 4)
16. Have you worked for the Federal Government in the last 24 months? (If Yes,
(1) Yes
(2) No
see Question 16 in SECTION C, page 4)
(1) Yes
(2) No
17. Have you served in the Armed Forces in the last 24 months?
(1) Yes
(2) No
18. Have you been employed by an educational institution in the last 24 months?
(1) Yes
(2) No
19. Are you a construction worker?
20. Are you a member of a union?
(1) Yes
(2) No
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