Office of Unemployment Insurance

Go online:
Operations
pua.unemployment.ohio.gov
P.O. Box 182720
Call: 1-833-604-0774
Columbus, Ohio 43218-2720

Forwarding Service Requested

Zachary R. Satterfield
1317 Rainbow Trl March 19, 2021
Waverly, OH 45690-9235 Claimant ID: 30099786

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 3/26/2021. 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

This notice is to inform you of changes to your claim and action you must take to continue receiving Pandemic
Unemployment Assistance (PUA). New federal legislation requires you to submit the following documentation
within 90 days of the date of this notice:

• Documentation of your income during the tax year prior to when you submitted your application
• Documentation proving your employment or self-employment, or the planned commencement of
employment or self-employment, during the tax year prior to when you submitted your application

Even if you previously submitted this documentation, U.S. Department of Labor rules require you to
resubmit it within 90 days of the date of this notice.

The following are examples of documents that may satisfy this requirement:

Proof of employment:

• Paycheck stubs
• Earnings and leave statements showing the employer’s name and address
• W-2 forms

Proof of self-employment:

• State or federal employer identification numbers

• Business licenses

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58101308
 • Tax returns
• Business receipts
• Signed affidavits from individuals who can verify your self-employment

Proof of employment with organizations such as the Peace Corps, AmeriCorps, or educational or religious
organizations:

• Documentation provided by these organizations and signed affidavits from individuals who can verify
your attachment to them

Proof of planned commencement of employment:

• Letters offering employment

• Statements/affidavits by individuals (with name and contact information) verifying an offer of
employment

Proof of planned commencement of self-employment:

• Business licenses
• State or federal employer identification numbers
• Written business plans
• Lease agreement

To submit the required documentation, click “Next” on the confirmation page that you will see after this page.
Once there, click “Yes” and select “Upload Document.”

If you fail to provide acceptable documentation within 90 days of the date of this notice, you are not
eligible for PUA, and any benefits you have received will be considered an overpayment.

This deadline may be extended if the Ohio Department of Job and Family Services finds that you have shown
good cause under state law for failing to submit the documentation by the required deadline.

If you have questions, please call 1-833-604-0774.

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: *

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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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