Pandemic Unemployment Assistance Form

Please fill out this form if you are having issues with the Pandemic Unemployment Assistance program.

Last four digits of SSN * *

Please reenter last four digits of your SSN to verify *

Issues with claim: *

Claim effective date (MM/DD/YYYY) (This is found by accessing your PUA dashboard and clicking on 'Claim Summary') *

Claimant ID number

Have you successfully filed your weekly certifications for all available weeks? *

When you access the summary of your weekly certifications, please indicate which of these messages you see: *

Did you at any point open a claim for regular Unemployment Compensation? *

What weeks specifically do you see ‘In progress, pending, excessive earnings, or disqualified’? Please give us specific dates (MM/DD/YYYY) for weeks you are inquiring about.