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Pennsylvania Unemployment Compensation FilingMaterials Checklist

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

YOUR INFORMATION:

Social Security Number *

Home address, mailing address (if different than your home address) and telephone number

Alien registration number, if you aren’t a U.S. citizen or national

DD Form 214, if you were on active duty in the U.S. military during the last two years

Information from Standard Form 8, Standard Form 50, W-2s and or pay stubs, if you worked for the federalgovernment in the last 18 months.

EMPLOYER INFORMATION:

Name of your last employer, or the employer where you’re currently working less hours

Complete mailing address of your last employer (name, street address, city, state, Zip Code)

Date you started working for that employer

Date of the last day you worked for the employer

Reason you left, or the reason you are working less hours

EMPLOYMENT HISTORY:

Names of all employers where you worked in the last 18 months (name, street address, city, state, Zip Code)

Start and end dates for all employers where you worked in the last 18 months

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 isn’t required to be eligible for or to receive UC benefits, but it is – by far – the easiest and mostonvenient way to get your money.)

Bank name, street address, city, state and Zip Code.

Bank telephone number

Bank account number

*

Bank account routing number

False statements are punishable pursuant to 18 Pa. C.S. §4904, relating to unsworn falsification to authorities. A person whoknowingly makes a false statement or knowingly withholds information to obtain UC benefits commits a criminal offense undersection 801 of the UC Law, 43 P.S. §871, and may be subject to a fine, imprisonment, restitution and loss of future benefits.

We can’t process your claim without your Social Security Number. UC is a taxable benefit, and the law requires us to report theamount you’ve received in benefits to the United States Internal Revenue Service. We also share information with other states toprevent identity theft and to fight fraud. Your Social Security Number and personal information won’t be shared with anyoneoutside state government employment compensation systems and the federal government’s tax system.

Auxiliary aids and services are available upon request to individuals with disabilities.

Equal Opportunity Employer/Program

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