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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
Ian J. Russo
2422 Edith Ct NE
Canton, OH 44705-2118
March 22, 2021
Claimant ID: 30334958
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 3/29/2021. 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.
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:
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
Self-employment ledger documentation
1040 SE with Schedule C, F, or SE
1065 Schedule K1 with Schedule E
Bookkeeping records, including receipts for all allowable expenses
Bank statements (personal and business)
Signed time sheets and receipt of payroll
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Quarterly or year-to-date profit and loss statement
3.
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.
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.
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.
6.
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.
Section 2
If you wish to provide any additional information about this issue, provide below.
Name and title of the person completing this request:
*
Telephone number of the person completing this request:
*
If you would like to be contacted by email as an additional method to contact you, please provide your email
address:
I certify that the above information is true and correct and I understand that the law provides penalties for
false information.*
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