Is your claim under review, appeal, or adjudication? If yes, visit https://www.uc.pa.gov/appeals/Pages/default.aspx *

Are you able to log in to your UC dashboard? If no, visit https://www.uc.pa.gov/unemployment-benefits/UCBenMod/Documents/Logging-into-the-UC-System.pdf *

What state did/do you work in? If you worked in a state other than PA, visit https://www.uc.pa.gov/unemployment-benefits/federal/pages/interstate-claims.aspx *

Is there an overpayment issue on your claim? If yes, do not complete this form. Visit https://www.uc.pa.gov/unemployment-benefits/overpayment-of-benefits/Pages/default.aspx *

Has there been fraud or identity theft (or the suspicion of) on your claim? If yes, visit this website, https://www.uc.pa.gov/pages/report-fraud-here.aspx, complete the steps and after you have done so, you may complete this form. *

Alternate phone:

Address on claim if different from current address. (Please include City, State, and ZIP Code)

New address (if change is needed) Street, City, State and Zip

Last Four Digits of SSN: *

Please reenter last 4 digits of SSN to verify *

Date of initial claim: *

Last day of work: *

Did you receive a Financial Determination Letter? *

Were you found financially eligible for benefits?

If you were found ineligible for benefits, and you disagree, did you file an appeal?

If you filed an appeal, on what date (MM/DD/YYYY)?

Have you successfully filed your first weekly claim? *

If you have successfully filed a weekly claim, are you still awaiting payment after 7 business days?

List the date(s) of the weeks(s) you filed but did not receive payment. If you have not yet filed a weekly claim, enter “none.” *

Have you reached out to another office for help with your unemployment? *

If yes, whose office and date contacted?