Authorization And Release For Disclosure Of Unemployment Insurance Information {DOL-5111}

DOL-5111 - AUTHORIZATION AND RELEASE FOR DISCLOSURE OF UNEMPLOYMENT INSURANCE INFORMATION/RECORDS. This form is issued by the Georgia Department of Labor (GDOL) that allows individuals to authorize the release of their confidential unemployment insurance (UI) records. This form is used when a claimant needs to share their unemployment information with a third party, such as an attorney, government agency, or employer. It requires completion of three main sections: Section I collects the claimant’s name, address, Social Security number, and contact information. Section II identifies the person or organization authorized to receive the UI information, along with their contact details. Section III specifies the information to be released, the purpose of the disclosure, and any additional authorized recipients. The form must be signed and notarized, as the Georgia Department of Labor cannot notarize it. A legible copy of a government-issued photo ID must accompany the completed form, which should be submitted to the UI Legal Unit by mail, fax, or email at 148 Andrew Young International Blvd NE, Suite 826, Atlanta, GA 30303. Applicable fees may be determined by the GDOL’s UI Legal Unit. The release complies with O.C.G.A. § 34-8-120 and 20 CFR Part 603 governing the confidentiality of unemployment insurance records. This Georgia DOL-5111 form authorizes the release of confidential unemployment insurance records to designated third parties for approved purposes. www.FormsWorkflow.com