Personal Records Release Requests

To request copies of your personal records from the Unemployment, Temporary Disability/Temporary Caregiver Insurance, or Worker's Compensation programs, complete the Personal Records Release Form below. 

Instructions For Completing Authorization for Disclosure of Personal Records in Person 

  1. Print clearly. 
  2. Section 1: Print the name of the person whose information will be released. 
  3. Section 2: Print the name and address of the person or organization authorized to receive the information. All records shall be sent via Certified mail. 
  4.  Section 3: Check all the boxes that apply. 
  5. The individual whose records are sought or their authorized representative must sign and date this form in black or blue ink in the presence of a Notary Public. Examples of authorized representatives include parents of minors, legal guardians, and power of attorney. You may complete this document at the DLT, and a Notary will be provided. Please call 401-462-8877 to schedule an appointment with a notary. Please understand that if you show up without an appointment, a notary may not be available for you. The address is 1511 Pontiac Avenue, Building 73-3, Cranston, Rhode Island 02920. 

Alternative Submission Instructions

 If the form was not completed in person, it can be submitted through the following methods: 

  1.  Submit the completed form via regular mail to 1511 Pontiac Avenue, Building 73-3, Cranston, Rhode Island 02920, c/o Legal Division. 
  2. Email the completed form to dlt.apra@dlt.ri.gov. 
  3. Fax the completed form to 401-462-8884, c/o Legal Division.