Office of Unemployment Insurance Operations P.O. Box 182720 Columbus, Ohio 43218-2720 Go online: pua.unemployment.ohio.gov Call: 1-833-604-0774 Forwarding Service Requested Jessica F. Dix c/o Jessica F Dix 1132 laird st, Apt 1 Akron, OH 44306 March 9, 2021 Claimant ID: 30209494 IMPORTANT! The following information is needed to determine if you can be paid benefits. It is critical that you understand the information in this document. If a question does not apply, state that in your answer. There is room at the bottom to add more information, if necessary. If providing additional documentation by mail, your response must be postmarked no later than 3/16/2021. If you do not respond by the due date, we will issue a decision based on the available information. If you need help understanding or with the translation of the information in this document, call 1-833-604-0774. Section 1 ODJFS needs the following forms of identification and documentation in order to further determine your eligibility for benefits. Please select the checkbox below for the documentation you will be providing as an attachment: 1. X Please submit a legible copy of your Social Security card, birth certificate, driver license/state identification, and a second photo identification (i.e. passport, permanent resident card, employment authorization card, military identification, company issued identification card from most recent employer(s), student identification card, etc.) 2. Please submit proof of your employment and/or income from 2018 through the present. This may include any of the following: X A copy of your 2018 and 2019 federal tax returns, along with a federal Schedule E wages and tax statement (W-2 and/ or 1099, including 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT) Pay stubs X Self-employment ledger documentation 1040 SE with Schedule C, F, or SE 1065 Schedule K1 with Schedule E X Bookkeeping records, including receipts for all allowable expenses Bank statements (personal and business) X Signed time sheets and receipt of payroll Page 1 of 2 Si usted no puede leer esto, llame por favor a 1-833-604-0774 para una traduccion. 55283442 Quarterly or year-to-date profit and loss statement 3. X Please submit proof of your residence for the address listed on your application – for example, utility bills or lease/mortgage documents. If you listed a post office box as your mailing address, please submit proof of ownership, such as copy of PS Form 1093. 4. X If you have claimed any dependents – a spouse and/or children – please provide a legible copy of their Social Security cards, birth certificates, driver’s licenses or state IDs, and/or proof of marriage/marriage certificate. 5. 6. If you have selected direct deposit as your payment preference, please submit a voided check or other form of backup documentation, including the name of the account owner(s), routing number and account number. Note: The bank account you are using must be in your name. X Please provide the name of your most recent employer and or self-employment and dates of employment. Please explain how your employment and/or self-employment was affected by COVID-19. Self employed cleaner Section 2 Clients are elderly it have children and do not feel safe me cleaning their residence at this time. If you wish to provide any additional information about this issue, provide below. Name and title of the person completing this request: Jessica F Dix Telephone number of the person completing this request: 330-937-0413 * * If you would like to be contacted by email as an additional method to contact you, please provide your email address: X I certify that the above information is true and correct and I understand that the law provides penalties for false information.* Page 2 of 2 Si usted no puede leer esto, llame por favor a 1-833-604-0774 para una traduccion.
