Help Display Area When a form field name is clicked during data entry, information specific to the topic in question will appear in this area of the screen.













Social Security Number (Mandatory)
Format: SSN: 999-99-9999
Meaning:  You must enter your Social Security Number when claiming Unemployment Insurance benefits.













Last Name  (Mandatory)
Format: Text
Meaning: Please enter your last name.







First Name  (Mandatory)
Format: Text
Meaning: Please enter your first name.






Middle Initial (Not Mandatory)
Format: Text
Meaning: Please enter the first letter of your middle name.






Other Last Name  (Mandatory)
Format: Text
Meaning: Please enter any other last name you have used.






Other First Name  (Mandatory)
Format: Text
Meaning: Please enter any other first name you have used.






Other Middle Initial (Not Mandatory)
Format: Text
Meaning: Please enter any other middle initial you have used.






Name Change  (Mandatory)
Format: Yes/No Buttons
Meaning: Please answer whether you have changed your name including maiden name in the last 12 months.






Date of Birth  (Mandatory)
Format: Date: mm/dd/yyyy or mm-dd-yyyy or mm.dd.yyyy
Meaning: Please enter your date of birth.







Education  (Mandatory)
Format: List of Choices
Meaning: Please choose the highest education level you have completed.  A degree is an academic rank conferred by a university or college.  A certificate is received and indicates the completion of some career training, other than a degree pursuit.  Please choose the selection that mostly closely applies to your education level .






Telephone Number  (Mandatory)
Format: Phone Number: (999) 999-9999 or (999)999-9999 or 999-999-9999 or 999.999.9999
Meaning: Please enter your residence telephone number, beginning with the area code. If a residence telephone number is unavailable, please enter a telephone number where you may be reached during the business hours of 8:00 a.m. to 4:00 p.m.






United States Citizenship  (Mandatory)
Format: Yes/No Buttons
Meaning: If you are a United States citizen, please click the "Yes" button. If you are not a citizen, please click the "No" button.






Alien Registration Number  (Mandatory)
Format: Text
Meaning: If you are not a citizen, you must enter the Alien Registration Number assigned to you by the Immigration and Naturalization Service. If you are a citizen, please return to the previous page and change your response to the "US Citizenship" question to Yes.






Dependents under 16 years of age  (Mandatory)
Format: Yes/No Buttons
Meaning: If you have any children (son, daughter, step-child, legally adopted child) under the age of 16 for which you supply support, please click the "Yes" button, otherwise click the "No" button.






Street of Residence  (Mandatory)
Format: Text
Meaning: Please enter your home address, including apartment number.






Street of Residence (Not Mandatory)
Format: Text
Meaning: Please enter the continuation of your home address, if you did not have enough room in the previous "Street of Residence" field.






State of Residence  (Mandatory)
Format: List of Choices
Meaning: Please select the state you live in.






City of Residence  (Mandatory)
Format: Text
Meaning: Please enter the city you live in.






Zip code of Residence  (Mandatory)
Format: Zip code: 99999 or 99999-9999
Meaning: Please enter your 5 or 9 digit Zip Code.






County of Residence  (Mandatory)
Format: List of Choices
Meaning: Please select the name of the county you live in.






Disability Status  (Mandatory)
Format: Yes/No Buttons
Meaning: This information is voluntary and is for statistical purposes only. Failure to provide this information will in no way affect your receipt of benefits to which you are entitled and for which you are eligible. You may choose not to identify your disability status by clicking the "Prefer Not To Answer" button. 







Ethnic Identification  (Mandatory)
Format: List of Choices
Meaning: This information is voluntary and is for statistical purposes only. Failure to provide this information will in no way affect your receipt of benefits to which you are entitled and for which you are eligible. You may choose not to identify your ethnic background by selecting "Prefer not to answer" or you may select your ethnic background from the pre-defined list of choices.






Did you work in Maryland in the last 18 months? (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you worked in Maryland during the last 18 months, otherwise enter "No". This includes any work performed: permanent or temporary, full-time or part-time.  It DOES NOT include any employment with the Federal Government or the military.  






Do you currently live in Maryland? (Mandatory)
Format: Yes/No Buttons
Meaning: Please answer whether you are currently living in Maryland. If you are not currently living in Maryland, you will be required to file your combined wage claim by telephone so that we can better assist you.






Do you have your SF-8 form?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you have your SF-8 form, otherwise enter "No".






Did you work in another state in the last 18 months?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you worked in another state during the last 18 months, otherwise enter "No". This includes any work performed: permanent or temporary, full-time or part-time.






Did you work for the Federal Government in the last 18 months?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you worked for the Federal Government during the last 18 months, otherwise enter "No". This includes any work performed: permanent or temporary, full-time or part-time.






Did you serve in the armed forces in the last 18 months?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you served in the Armed Forces during the last 18 months, otherwise enter "No".






Did you claim benefits within the last 12 months?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you claimed benefits within the last 12 months, otherwise enter "No".






If yes, against what state?  (Mandatory)
Format: List
Meaning: If yes, please select a state.







Are you able to work full time?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please select "Yes" if you are able to work full-time (35 or more hours weekly), otherwise select "No".  If additional information is needed from you in response to this question, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






Are you attending school during normal work hours?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please select "Yes" only if you are attending school during normal work hours for your occupation, otherwise select "No".   School includes public and private institutions and can mean college, high school, vocational, or GED equivalency training.  If additional information is needed from you in response to this questions, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






Hiring Hall Number (Not Mandatory)
Format: Number
Meaning: Please enter the hiring hall number, if you are a member of a union which has a hiring hall. If you do not belong to a union with a hiring hall, leave this field blank.






Select how you will get to and from work  (Not Mandatory)
Format: List of choices
Meaning: Please choose from the list the way you will most often use to get to and from work .






Are you self-employed?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please select "Yes" if you are self-employed, otherwise select "No".  If additional information is need from you in response to this question, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






Do you have a valid driver's license?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please select "Yes" if you have a valid driver's license, otherwise select "No".






Do your children need care while you work?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please select "Yes" if your children need care while you work, otherwise select "No".  If additional information is needed from you in response to this question, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






Will you have child care if offered a job?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please select "Yes" if you will have child care if offered a job, otherwise select "No".  If additional information is needed from you in response to this question, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview..






Class of license  (Mandatory)
Format: List of choices
Meaning: Please select the class of license as listed on your driver's license.






Work Type (Not Mandatory)
Format: List of choices
Meaning: Select the best match in the list for the work type you are looking for.  The descriptions provided are the broad descriptions of the nine major occupational types defined in the Federal Dictionary of Occupational Titles.    If you do not find one on the list that applies to the type of work you are seeking, please choose "No Answer Given".






Explanation for not having child care available  (Mandatory)
Format: Text
Meaning: Please explain the reason you will not have child care available if offered a job.  This field will accept no more than 58 characters so please keep your explanation brief.  If additional information is need from you in response to this question, you will receive a notice in the mail informing you of scheduled telephone fact finding interview.






During weeks that you expect to claim unemployment insurance, are you receiving or will you receive Social Security, other than a widow's or survivor's pension?  (Question deleted from the form)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you are receiving Social Security, other than a widow's or survivor's pension, otherwise enter "No".






During weeks that you expect to claim unemployment insurance, are you receiving or will you receive a Federal Pension?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you are receiving a pension from the Federal Government (civilian and/or military), otherwise enter "No".  If additional information is needed from you in response to this question, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






During weeks that you expect to claim unemployment insurance, are you receiving or will you receive any other pension?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you are receiving a pension from any other public or private employer, otherwise enter "No".  If additional information is needed from you in response to this questions, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






During weeks that you expect to claim unemployment insurance, are you receiving or will you receive a lump sum pension?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if are receiving a lump sum distribution of a pension, otherwise enter "No".  If additional information is needed from you in response to this question, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






During weeks that you expect to claim unemployment insurance, are you receiving or will you receive profit sharing?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you are receiving distributions from profit sharing, otherwise enter "No".  If additional information is needed from you, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






During weeks that you expect to claim unemployment insurance, are you receiving or will you receive bonus/special pay?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you are receiving bonus or other special pay, otherwise enter "No".  If additional information is needed from you in response to this question, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






During weeks that you expect to claim unemployment insurance, are you receiving or will you receive severance pay?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you are receiving severance pay from your most recent employer, otherwise enter "No".  If additional information is needed from you in response to this questions, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






During weeks that you expect to claim unemployment insurance, are you receiving or will you receive vacation or holiday pay?  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you are receiving vacation or holiday pay from your most recent employer AND your employer provided you with a return to work date.  Enter "No" if you are not receiving vacation or holiday OR you are receiving holiday or vacation pay but your employer did not provide you with a return to work date.  If additional information is needed from you in response to this question, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






State Withholding  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you want State Withholding deducted from your unemployment insurance benefit (7% of your benefit amount will be withheld), otherwise enter "No".  A form will be mailed to you to verify your request to have State income tax withheld from your unemployment insurance benefits. No deduction will be made from your weekly benefit amount until you have signed the form and returned it to the address shown on the form.






Federal Withholding  (Mandatory)
Format: Yes/No Buttons
Meaning: Please enter "Yes" if you want federal Withholding deducted from your unemployment insurance benefit (10% of your benefit amount will be withheld), otherwise enter "No".  A form will be mailed to you to verify your request to have Federal income tax withheld from your unemployment insurance benefits. No deduction will be made from your weekly benefit amount until you have signed the form and returned it to the address shown on the form.






Type of Work  (Mandatory)
Format: Text
Meaning: Please enter your job title, describing the type of work that you were doing for this employer.






State of Employment  (Mandatory)
Format: Text
Meaning: Please enter state in which you performed the job you described.






Payroll State  (Mandatory)
Format: Text
Meaning: Please enter the payroll state.






Payroll Zipcode  (Mandatory)
Format: Text
Meaning: Please enter the payroll zipcode.






Are you willing to work all hours? (Mandatory) 
Format: Yes/No Buttons  
Meaning: Please select "Yes" if you are willing to work all hours and shifts that are customary in your occupation.  Please select "No" if you are not willing to work all hours and shifts that are customary to your occupation.  If additional information is needed from you in response to this question, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.





Do you typically commute to Maryland to work or to look for work?  (Mandatory)
Format: Yes/No Buttons
Meaning: If you commute to Maryland to work or look for work, please click the "Yes" button. If you do not commute to Maryland, please click the "No" button.






Provide the reason you are not able to work full time.  (Mandatory)
Format: List of choices
Meaning: Choose the response from the list that most closely matches the reason you are currently not able to work full-time.  If additional information is needed from you in response to this question, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






Provide the reason you are not able to work full time.  (Mandatory)
Format: Text, up to 60 characters
Meaning: Please explain the reason you are currently not able to work full-time. This field will accept no more than 60 characters so please keep your explanation brief.  If additional information is needed from you in response to this questions, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






Provide the reason you are not willing to work all hours.  (Mandatory)
Format: Text, up to 60 characters
Meaning: Please explain the reason you are currently not willing to work all hours. This field will accept no more than 60 characters so please keep your explanation brief.  If additional information is needed from you in response to this question, you will receive a notice in the mail informing you of a scheduled telephone fact finding interview.






E-mail address (Optional)
Format: Text
Meaning: Please enter your e-mail address.  Your email address must be no more than 50 characters and must  include the @ sign. Most Unemployment Insurance business if conducted by telephone or mail, however we also hope to use email for future contacts.

Have you worked, even for one day, anywhere, since the last time you filed a claim for unemployment insurance against Maryland? (Mandatory) 
Format: Yes/No Buttons 
Meaning: Please select "Yes" if you have worked at any time, even if it was for only one day and even if you have not yet been paid, since the last time you filed a claim for unemployment insurance.  Please select "No" if you have not worked at all since the last time you filed a claim for unemployment insurance. Print Admin Report
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Document Type (Optional)
Format: List of choices
Meaning: Please enter your type of document which describes your immigration status. If you do not have an immigration document, please select 'No Document Available'.











Other Information (Optional)
Format: Text
Meaning: Please provide further information on your immigration documentation. 











Expiration Date (Optional)
Format: Date
Meaning: Please enter the expiration date of your immigration document. 











Departure Number (Optional)
Format: Number
Meaning: Please enter your departure number.