Sign New Hampshire Claim Now

Initials claim

[Music] pandemic unemployment assistance or PUA is a program under the coronavirus aid relief and Economic Security or cares Act of 2020 that provides unemployment assistance to workers who are not eligible for regular unemployment insurance compensation PUA provides temporary benefits to eligible individuals who are self-employed independent contractors lack sufficient work history do not qualify for a regular unemployment claim or have exhausted other forms of unemployment insurance benefits if you believe you may be eligible for regular UI claim you should file a claim using the online claim system if the Oregon Employment Department determines that your claim is not valid you will be able to apply for PUA assistance if you know you are not eligible for regular UI and are seeking benefits under this new program please submit your application our website will direct you to either file a regular UI claim or a PUA claim these are two separate application processes if you have already filed a regular UI claim and do not qualify you will need to submit a separate PUA application before you begin completing your pandemic unemployment assistance application make sure you save the form to your device and open it directly in Acrobat or Acrobat Reader if possible this allows you to tab through the application easily the fillable PDF form will not automatically save it is strongly recommended that you periodically save data entered into a form by using the Save button on the form or by clicking file save or save as after you have completed the application save a final version of the file to your device and view it to ensure all fields are complete to help you file your PUA application let's walk you through each section of the application now section a applicant information please provide your personal information including your social security number this information is needed to verify your identity and establish a PUA claim section B applicant employment it is important that you provide all of your employment history including any self-employment you have done during the last 18 months this information will be used to verify your employment along with any proof of earnings you provide in order to be considered for a higher weekly benefit amount section C eligibility questions were you scheduled to start a new job that has since closed as a direct result of the Cova Dean public health emergency answer yes if you are unable to reach your job because doing so would require the violation of the stay home save lives order or the employer has closed the place of employment answer yes if you do not have a job because the employer postponed the job offer as a direct result of the Cova 19 public health emergency answer yes if you do not have a job because the employer rescinded the job offer as a direct result of the Cova 19 health emergency did you apply for receive or would you be eligible to receive if you had ever applied for unemployment compensation under any state or federal law answer yes if you have received payment from any of our unemployment programs such as regular unemployment insurance unemployment insurance for civilian federal employees unemployment insurance for ex servicemembers disaster unemployment assistance work share benefits payment under the self-employment assistance program the pandemic emergency unemployment compensation which is the thirteen week extension to regular benefits or extended benefits question to any amounts for loss of wages due to illness or disability answer yes if you have received any workers compensation or disability pay question three any type of private income protection insurance answer yes if you received any insurance benefits from being unable to work for a period of time because of illness our injury question for any amount as a supplemental unemployment benefit answer yes if you are paid benefits in accordance with a collective bargaining agreement such as extended layoff benefits or fertil benefits these are payments but are not wages but provided as part of supplemental unemployment benefits are you receiving or will you receive retirement pay other than Social Security within the next 12 months answer yes only if you are receiving or you will receive retirement pay within the next twelve months other than Social Security next is a series of questions regarding how you may have been impacted by the Cova nineteen public health emergency these are yes or no questions if you answer yes to any of these questions you will need to provide the date that you were impacted and the name of the facility person or employer have you been diagnosed with kovat 19 or are you experiencing symptoms of kovat 19 and seeking a medical diagnosis answer yes if you have been diagnosed by a qualified medical professional or you are seeking a medical diagnosis because you are experiencing symptoms answer no if you are not experiencing symptoms or if you are experiencing symptoms but you are not seeking a medical diagnosis has a member of your household been diagnosed with kovat 19 answer yes only if a member of your household has been diagnosed as having kovin 19 by a qualified medical professional or has tested positive for kovat 19 and you are unable to work as a result answer no if a member of your household is experiencing symptoms but has not yet been diagnosed with Kovan 19 are you caring for a family member or a member of your household who has been diagnosed with Kovan 19 answer yes if the care requires such ongoing and constant attention that your ability to perform other work functions is severely limited answer no if you are assisting a family member who is able to adequately care for themselves is there a child or other person in the household for whom you have the primary care giving responsibility for that is unable to attend school or another facility that closed as a direct result of the Cova deny teen public health emergency and such school or facility care is required for you to work answer yes if you are required to remain at home to provide care for that child or other person in the household answer yes if your job allows for telework but the amount of care requires such ongoing and constant attention that it is not possible for you to perform work at home have you become the breadwinner or provider of majority support for a household because the head of the household has died as a direct result of kovat 19 answer yes if the head of household previously contributed the majority of financial support has died as a direct result of Kovach 19 and you are now the person in the household expected to provide financial support has your place of employment closed as a direct result of the Cova 19 public health emergency answer yes if your employer shut down due to an emergency declaration are due to necessary social distancing protocols have you quit a job as a direct result of kovat 19 answer yes if you have been diagnosed with Kovan 19 by a qualified medical professional or we're experiencing symptoms and seeking a diagnosis but your employer was unable to accommodate your situation by allowing you to work from home or take time off and you had to leave work answer yes if you had to care for another individual either because they were ill or because their normal care facility was closed such as daycare or school or elder care and you had to quit work because your employer could not accommodate your situation by allowing you to work from home or to take time off are you unable to reach your place of employment because you have been advised by a healthcare provider to south quarantine due to concerns related to kovat 19 answer yes if you have been advised by a qualified medical professional they you may be infected with the corona virus and that you should self quarantine answer yes if you had direct contact with another person who has been tested positive for the corona virus or had been diagnosed with kovat 19 by a qualified medical professional and have been advised by a healthcare provider to self quarantine to prevent further possible spread of the virus such circumstances would render you unable to reach your place of employment answer yes if your immune system is compromised because of a serious health condition and you have been advised to by a health care provider to self quarantine in order to avoid the greater than average health risks that you might face if you were to become infected by the corona virus are you unable to reach your place of employment because of a quarantine imposed as a direct result of the Cova 19 public health emergency answer yes if you are unable to reach your place of employment because doing so would require the violation of the stay home save lives order do you have the ability to continue to receive payment from your employer while working from home answer yes if you have been offered the option of continuing to work for pay by teleworking and have refused such offer answer yes if you have been offered the option of continuing to work for pay by teleworking and have accepted the offer but you are working less than what you are performing prior are you receiving paid sick leave or other paid leave benefits answer yes if you are receiving any paid leave benefits for your customary work hours this includes sick leave vacation and any other paid leave are you currently self-employed answer yes if you have performed self-employment within the most recently completed tax year Section D self-employment information complete this section only if you have performed self-employment within the most recently completed tax year if you have not performed self-employment please skip this section and complete section e we understand that these questions do not apply to all self-employment situations however these questions are required for all individuals who indicate that they have been self-employed please do your best to respond to the questions in this section at the time of the pandemic was this self-employment your primary occupation and primary means of livelihood if you answer no please explain what is your primary occupation and primary means of livelihood if it is not self-employment what services did you perform please describe the type of services you perform for your business in the space below do you have a business name if you have a business name please provide the name in the space below do you file a business return such as a Schedule C 1120 or a 10 65 some business returns are part of your personal income tax return you can answer yes even if you are filing your business income with your personal return if you file a business return please provide the type of business return that you file in the space below do you determine how the work is to be performed answer yes if you decide how you perform your work answer know if the company you provide service for determines how you perform your work do you have the right to hire someone to help you perform your services answer yes if you can hire employees for your business answer no if the company you provide services for does the staff hiring or strictly prohibits you from hiring others to assist you if yes can you discharge them answer yes if you also have the ability to fire your employees answer no if the company you provide service for is the one who fires employees do you determine where the work is going to be performed answer yes if you determine where your work will be performed answer no if the company provides services for determines where the work will be performed do you determine your rate of compensation answer yes if you determine your rate of pay answer no if the company you provide services for determines your rate do you have an investment in tools or equipment answer yes if you have an investment in tools equipment or anything else towards your business and list how much you have invested in the space below can the company you provide services to terminate you answer yes if the company or clients you provide services to can terminate your employment at any time do you have more than one client answer yes if you have more than one client and lists the number of clients you have in the space below section e authorization for tax withholding all benefits you receive under PUA are taxable income if you are required to file a tax return you must authorize the Employment Department to withhold federal and/or state taxes from your unemployment insurance benefits section F retroactive filing PUA is payable beginning the week of February 2nd 2020 or the first week you became out of work due to kovat 19 whichever is later this section allows you to retroactively Li claim up to six prior weeks for PUA please enter the week ending date for each week you wish to claim if you need to claim for more than six weeks please complete a separate weekly certification for each week you would like to request for unemployment purposes our weeks are Sunday through Saturday for each week you wish to claim benefits please list the Saturday date of that week for example if you want to claim for the week of April 19th 2020 through April 25th 2020 you would enter Saturday April 25th 2020 in the week ending column please list the total hours of work you performed please provide your total gross earnings for each week if you are self-employed report any earnings you received regardless of whether you work during that week if you are employed as an employee report any earnings you will receive from work performed during the week regardless of whether you have received the pay or not please use the drop down to select what type of earnings you received during each week the first question has four sub questions did you apply for or receive any insurance payments for loss of wages due to illness or disability be any payments from private income protection insurance see any payments of a supplemental unemployment benefit d where any amounts payable to you from any retirement pension or annuity payments from a plan contributed or maintained by an employer you receive payments from in 2019 if you answered yes to any of the questions in a 3 D please provide details regarding each payment in the box below question - were you able and available for work during this week based on our state requirements answer yes if you were able and available for work based on the Oregon Employment Department s-- current temporary rules if you are unsure please go to our website for more information are you currently impacted by the Koated 19 public health emergency answer yes if you are currently impacted by kovat 19 answer no if you are not currently impacted by kovat 19 if yes please explain in the space below how you are currently impacted question 4 did you refuse any work during any of the weeks claimed above answer yes if an employer offered you work but you refused regardless of the reason section g rely a card disclosure the employment department pays unemployment insurance benefits electronically either by direct deposit or a u.s. bank R'lyeh card visa debit card if you do not apply for a direct deposit you will be sent a reliant n days after receiving your first payment for all new claims the first payment is usually sent by paper check with the US bank R'lyeh card visa we deposit your payments on to a prepaid debit card this card can be used anywhere visa cards are accepted section H misrepresentation you must read and agree to the misrepresentation advisory to process your claim this notifies you that if you intentionally lie or emit information to get UI benefits for which you are not entitled you must repay benefits including monetary and other penalties and may be subject to criminal prosecution section I applicant certification please sign your name and date your application without your certification we cannot process your claim what's next if you are found to be eligible for a PUA we will establish a minimum claim of two hundred and five dollars if you wish to have us evaluate your claim for an increased weekly benefit amount you must provide proof of your income for your most recently completed tax year in order to have the possibility of a higher claim amount you must have earnings in excess of sixteen thousand four hundred and eighty dollars for the year 2019 if you are self-employed you may provide your most recent tax return with your net income you may also provide profit loss statements if you have not filed your taxes yet showing your net income for your business if you are employed by someone else you may provide your w-2 or pay stubs for a tax year 2019 January through December make sure you claim your benefits each week you wish to receive payment after you have filed your claim you'll receive a wage and potential benefit letter in the mail advising you that you do not qualify for an unemployment claim this is only advising you that you do not qualify under regular unemployment insurance benefits after your claim is processed as a PUA claim you will receive a new letter advising you of your new eligibility under pandemic unemployment assistance thank you very much for your time we understand it's very difficult out there right now so please remember to stay safe [Music]