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Home
Meet Senator Theis
In the News
Press Releases
Photos
Audio
Video
Resources
Publications
District
Subscribe to my email list
Past Email Newsletters
Request a congratulatory certificate
Contact
Unemployment Assistance
UIA-4
Name
*
First
Last
*
Last
Phone
*
Email
*
Address (including any apt, lot, or unit number)
*
City
*
State
*
ZIP
*
UIA Claim number
*
Letter number of last correspondence from UIA
*
Date first became unemployed
*
Date you originally filed claim
*
Have you received any payments?
Yes
No
If you are missing payments, how many?
Are you able to certify your weeks?
Yes
No
Have you been unable to certify for more than 4 weeks?
Yes
No
Have you been paid in the last four weeks?
Yes
No
Have you received an Overpayment/Restitution letter?
Yes
No
Date of the Overpayment/Restitution letter?
Brief description of current issue with claim, status of claim
*
Submit
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