- Have you received or will you receive holiday pay during the period of Sunday (week 1 beginning date) through Saturday (week 2 ending date)? Tip: Make sure you have your holiday pay amount available.
- If yes, enter the gross amount of your holiday pay (before deductions) for each week.
- Did you work during the period of Sunday (week 1 beginning date) through Saturday (week 2 ending date)? Tip: Have your gross earnings before taxes and other deductions available.
- If yes, enter the total amount of earnings (before deductions) for each week.
- Has your dependency status changed during this certification period?
- Were you able and available to work each day during your normal work week?
- If no, enter the number of days you were unavailable for work in each of the weeks.
- Did you actively look for work for the week of Sunday (week 1 beginning date) through Saturday (week 2 ending date)
- Are you receiving or have you applied for primary Social Security benefits?
- Other than Social Security, are you receiving, or have you applied for a retirement or disability pension?
- If yes, has the amount changed?
- Did you attend school or receive training?
- If yes, did you attend all scheduled training courses?
- If no, enter the number of days that you did not attend class.
- Do you have a current workers' compensation claim or do you expect to receive workers' compensation for a temporary disability?
- Has your phone number changed?
- If yes, enter your new ten-digit telephone number.
- Has your mailing address changed?