Address Change Request Form printable pdf download

Address Change Request Form

In Rhode Island, all unemployment insurance (UI) benefits are fully taxable and must be reported

with your annual tax return.

In order to be sure that the Department has accurate address information so that you receive

your 1099G, we require current address information



if you have moved since the last time you received unemployment insurance benefits in

2009,



you believe the Unemployment Insurance Service Center (UISC) may have an incorrect

mailing address for you on your 2009 payment file.

If either of these is the case, please complete this form and return to the UISC address listed

below by January 18, 2010. Please print clearly.

By completing the following information, I hereby notify the Department of Labor and

Training that I have moved. My new mailing address is:

Last four digits of your SSN: xxx-xx-___________

First Name:_________________Middle Initial:___Last Name:________________________

Date of Birth:_______

Street:_________________________________________Apt. Number__________________

City:__________________________________

State:________ Zip:_________

Please return this form to:

Unemployment Insurance Service Center

PO Box 20380

Cranston, RI 02920

Address Change Request Form