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District 16 Unemployment Insurance Assistance Form
*NOTE*: Please only fill out this form if you are a resident of Maryland's 16th legislative district. To confirm which district you live in, please use the following link:
mdelect.net
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Last Name
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Your answer
First Name
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Your answer
Street Address
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Your answer
City
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Your answer
Zip Code
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Your answer
Last 4 Digits of Social Security #
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Your answer
Phone Number
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Your answer
Email Address
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Your answer
Please explain your issue clearly and we will attempt to assist you to the best of our ability. *PLEASE KEEP YOUR ANSWER WITHIN 255 CHARACTERS AS THAT IS ALL THE DEPARTMENT OF LABOR ALLOWS US TO SUBMIT*
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Your answer
Claimant ID # (if available)
Your answer
What date did you first apply for unemployment?
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