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.

Request for Personal Records Release PDF file, less than 1

Instructions to Submit

Personal Record Release Forms can be submitted in the following ways:

In Person: You may complete this document at the DLT, and a Notary will be provided by appointment. Please call 401-462-8877 to schedule an appointment with a notary. 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.
Mail: Submit the signed and notarized form via regular mail to 1511 Pontiac Avenue, Building 73-3, Cranston, Rhode Island 02920, c/o Legal Division.
Email: Email the signed and notarized form to Marangely Ortiz, Legal Secretary, at Marangely.Ortiz@dlt.ri.gov.
Fax: Fax the signed and notarized form to 401-462-8884, c/o Legal Division.