Pandemic Unemployment Assistance Form

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

**PLEASE NOTE: This form is only applicable for people who live in 34th District. To find out in which district you live and how to reach out to your state representative, please click here.

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.