Pennsylvania Unemployment Compensation Filing Materials Checklist

Use this checklist to gather the information you need to successfully file your UC claim. Keep a copy of this checklist with you when you file your claim.
YOUR INFORMATION:

c Social Security Number* c Home address, mailing address (if different than your home address) and telephone number c Alien registration number, if you arent a U.S. citizen or national c DD Form 214, if you were on active duty in the U.S. military during the last two years c Information from Standard Form 8, Standard Form 50, W-2s and or pay stubs, if you worked for the federal government in the last 18 months.
EMPLOYER INFORMATION:

c Name of your last employer, or the employer where youre currently working less hours c Complete mailing address of your last employer (name, street address, city, state, Zip Code) c Date you started working for that employer c Date of the last day you worked for the employer c Reason you left, or the reason you are working less hours
EMPLOYMENT HISTORY:

c Names of all employers where you worked in the last 18 months (name, street address, city, state, Zip Code) c Start and end dates for all employers where you worked in the last 18 months c Wages you earned for all employers where you worked in the last 18 months, and how you were paid (hourly, weekly, monthly)
DIRECT DEPOSIT INFORMATION:

(Direct deposit isnt required to be eligible for or to receive UC benefits, but it is by far the easiest and most convenient way to get your money.) c Bank name, street address, city, state and Zip Code. c Bank telephone number c Bank account number c Bank account routing number
*We cant process your claim without your Social Security Number. UC is a taxable benefit, and the law requires us to report the amount youve received in benefits to the United States Internal Revenue Service. We also share information with other states to prevent identity theft and to fight fraud. Your Social Security Number and personal information wont be shared with anyone outside state government employment compensation systems and the federal governments tax system. False statements are punishable pursuant to 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. A person who knowingly makes a false statement or knowingly withholds information to obtain UC benefits commits a criminal offense under section 801 of the UC Law, 43 P.S. 871, and may be subject to a fine, imprisonment, restitution and loss of future benefits.

Auxiliary aids and services are available upon request to individuals with disabilities. Equal Opportunity Employer/Program
UC-23 12-11