Unemployment Case Intake Form

Please enter your First and Last Name
Please enter your address, including city and zip code.
Please enter the phone number linked to your unemployment case
Please enter your email address
Please enter your date of birth MM/DD/YYYY
Please enter the last four digits of your social security number
Please enter all relevant information regarding your case. If you would like to forward any relevant documents relating to your case, please email them to Sen.Ballweg@legis.wisconsin.gov
Please enter how long you have been waiting.
Please enter one