Unemployment Publications and Forms

Employers: Tax Publications and Forms

Benefits Publications

Benefits Forms

 

Form #
Form Name and Description
B-9.2 Initial Claim Form with Instructions
Printable application form for New Unemployment Claims.
B-9.3 Verification of Earnings
This form allows an employer to verify a claimant's weekly earnings
B-100 Weekly Claim Form
This Weekly Claim form is provided as a substitute claim form only. It can be used only when authorized by the Bureau of Unemployment Compensation. You must be a currently active claimant to use this form.
B-101 Work Search Log
This form is used to record weekly work search contacts for a five-week period. After five weeks, notification goes to the claimant to return the completed Work Search Log. If a claimant returns to work, the Work Search Log should be returned immediately to the UC Claims Center.
B-4A How to File Your Weekly Benefit Claim (Me. B-4A)
Instructions on how to file weekly claims for unemployment benefits.
W-4V Income Tax Voluntary Withholding Form
Provides for the voluntary withholding of state and federal income taxes from Unemployment Compensation. Includes I-5 Instruction sheet.
I-1 Unemployment Poster (Me. I-1)
Employers required to provide unemployment compensation coverage for their employees must post this notice.
I-3 Benefits Rights Booklet - What Every Worker Should Know
What Every Worker Should Know About Unemployment Benefits (Information about every claimant's rights and responsibilities)
B-70 Dependents Claim Form
Information required to claim a dependency allowance.
B-7 Alien Verification Form
Information required to verify Alien Status for non-citizens and request for copy of alien card.
ETA-858A (1) Weekly Request for Allowances
Weekly Request for Allowances Only - Daily Travel/Subsistence for Trade Readjustment Allowances and North American Free Trade Agreement Programs.
B-100 (DWB) Dislocated Worker Benefits Weekly Claim Form
Verification of attendance at training for Dislocated Worker Benefts claims.
DWB-1 Dislocated Worker Benefits
Initial Application for Dislocated Worker Benefits.
I-23 TRA Trade Readjustment Assistance Act - Work Search Requirements
Explanation of Work Search and Suitable Work Requirements under the Trade Readjustment Allowances and North American Free Trade Agreement Programs.
UC-3 Request for Commission Hearing for Income Tax Refund Offset
Used to request a commission hearing when an Income Tax Refund is being offset.
UIC-1 Overpayment Waiver Information
Information on how to request a waiver of an unemployment benefit overpayment through the Unemployment Insurance Commission.
B-170 Application for Direct Deposit
Unemployment benefit checks can be direct deposited into your checking or savings account. Use this application to start or stop direct deposit.
ETA-858A (2) Weekly Request for Allowances and Attendance Form for TAA/TRA
Weekly Request for Benefits and/or Daily Travel/Subsistence Allowances (combined form) for Trade Readjustment Allowances and North American Free Trade Agreement Programs
FD-1 Reporting Potential Unemployment Fraud
You can report instances of unemployment fraud by using this form.
B-2 (EUC08) Emergency Unemployment Compensation 2008 (EUC08) Application
This form is used to file for Emergency Unemployment Benefits (EUC08)
TRA-17A Trade Readjustment Assistance Act (Brochure A)
Explanation of benefits and allowances available for Trade Readjustment Allowances and the Trade Adjustment Assistance Programs. (For Trade Certifications Numbered 50,000 - 69,999 or 80,000+)
TRA-17B Trade Readjustment Assistance Act (Brochure B)
Explanation of benefits and allowances available for Trade Readjustment Allowances and the Trade Adjustment Assistance Programs. (For Trade Certifications Numbered 70,000)
B-70.1 Dependents Claim Form - Continuation Sheet
Continuation sheet for listing additional dependent children when using the Form Me. B-70
BD-4.7 (Web) Medical Information
This form can be used when medical information is required in order to process a claim for unemployment compensation.