8/2/2020 Disaster Unemployment Assistance Certification Questions

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Disaster Unemployment Assistance Certification Questions

1 Week 1 2 Week 2 3 Review and Submit 4 Confirmation

Certification Questions Certification Questions

To certify for benefits, answer the questions below. When answering question #1 and #2 below, if you are well enough to work, are available for work, and the only
reason you can’t work is because you must quarantine or you are prevented from reaching work or businesses are not open due to the COVID-19 pandemic, then you
should answer “no.”

*Indicates required field

Week 1: 07/19/2020 - 07/25/2020

You have 2 Weeks Available. Answer the questions on this page for Week 07/19/2020 - 07/25/2020
1. *Were you too sick or injured to work for reasons other than disaster? Yes No
1a. If Yes, enter the number of days (1 - 7) you were unable to work. (1 - 7)

2. *Was there any reason (other than sickness, injury or the disaster) that you could not have accepted full-time work, each Yes No
workday?
3. *Did you look for work or contact your last employer, or, if self employed, did you attempt to resume self- employment? Yes No
4. *Did you refuse any work? Yes No
5. *Did you receive disability, private income insurance, or supplemental unemployment benefits? Yes No
6. *Did you work or earn money, whether you were paid or not? If self-employed, report earnings during the week you receive Yes No
the money.

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8/2/2020 Clarification
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Clarification

1 Week 1 2 Week 2 3 Review and Submit 4 Confirmation

Clarification Certification Questions

One or more questions that you answered require(s) further clarification and information. Answer the questions below.

*Indicates required field

Week 1: 07/19/2020 - 07/25/2020

You indicated in question 6 that you did not work or earn any money this week, whether you were paid or not. Answer the question below.
1. *Did you receive any other type of income such as the following? Yes No

Pension
Residual Pay or Holding Fees
Severance or Employment Separation Pay
Vacation or Hiatus Pay
Jury Duty
Sick Leave Pay
Holiday Pay
Workers’ Compensation
Wage Continuation Pay
Bonus
In Lieu of Notice Pay
WARN Pay
Witness Fees not including Mileage Reimbursement
Back Pay Award
Incentive Pay
Idle Time/Show Up or Stand-by Pay
Royalties
Supplemental Unemployment Benefits
Script Option Payment
Retirement Funds Disbursement (401k, etc) Lump Sum
Profit Sharing
Strike Benefits

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8/2/2020 Disaster Unemployment Assistance Certification Questions
Skip to Content
Help ( AMY BRAWNER ) | Benefit Programs Online | Log Out

Certify for Benefits Payment Activity Claim History Form 1099G Personal Profile Inbox Contact Us

Disaster Unemployment Assistance Certification Questions

1 Week 1 2 Week 2 3 Review and Submit 4 Confirmation

Certification Questions Certification Questions

To certify for benefits, answer the questions below. When answering question #1 and #2 below, if you are well enough to work, are available for work, and the only
reason you can’t work is because you must quarantine or you are prevented from reaching work or businesses are not open due to the COVID-19 pandemic, then you
should answer “no.”

*Indicates required field

Week 2: 07/26/2020 - 08/01/2020

You have 2 Weeks Available. Answer the questions on this page for Week 07/26/2020 - 08/01/2020
1. *Were you too sick or injured to work for reasons other than disaster? Yes No
1a. If Yes, enter the number of days (1 - 7) you were unable to work. (1 - 7)

2. *Was there any reason (other than sickness, injury or the disaster) that you could not have accepted full-time work, each Yes No
workday?
3. *Did you look for work or contact your last employer, or, if self employed, did you attempt to resume self- employment? Yes No
4. *Did you refuse any work? Yes No
5. *Did you receive disability, private income insurance, or supplemental unemployment benefits? Yes No
6. *Did you work or earn money, whether you were paid or not? If self-employed, report earnings during the week you receive Yes No
the money.

The following questions apply to both certification weeks:

7. If you want federal income tax withheld for the week(s), check the box to the right.
If submitted to withhold voluntary federal income tax, EDD cannot refund these funds because they will have already been
transmitted to the IRS.

8. If you had a change of mailing address or phone number, check the box to the right.

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8/2/2020 Clarification
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Clarification

1 Week 1 2 Week 2 3 Review and Submit 4 Confirmation

Certification Questions Clarification

One or more questions that you answered require(s) further clarification and information. Answer the questions below.

*Indicates required field

Week 2: 07/26/2020 - 08/01/2020

You indicated in question 6 that you did not work or earn any money this week, whether you were paid or not. Answer the question below.
1. *Did you receive any other type of income such as the following? Yes No

Pension
Residual Pay or Holding Fees
Severance or Employment Separation Pay
Vacation or Hiatus Pay
Jury Duty
Sick Leave Pay
Holiday Pay
Workers’ Compensation
Wage Continuation Pay
Bonus
In Lieu of Notice Pay
WARN Pay
Witness Fees not including Mileage Reimbursement
Back Pay Award
Incentive Pay
Idle Time/Show Up or Stand-by Pay
Royalties
Supplemental Unemployment Benefits
Script Option Payment
Retirement Funds Disbursement (401k, etc) Lump Sum
Profit Sharing
Strike Benefits

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Copyright © 2018 State of California

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8/2/2020 Review and Submit Disaster Unemployment Assistance Certification
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Review and Submit Disaster Unemployment Assistance Certification

1 Week 1 2 Week 2 3 Review and Submit 4 Confirmation

Pending Submission Pending Submission

Review the information below.

For changes or corrections, select the Previous button to return to the previous page.

If the information is correct, follow these steps:

check the Acknowledgement box,

enter your mailing address ZIP Code, and
select the Submit button.

By following these steps, this submission serves as your electronic signature that you answered the certification questions correctly and honestly.

Note: You will NOT be able to change any answers once the Submit button is selected.

*Indicates required field

Week 1 Week 2
Summary of Certification Questions and Answers 07/19/2020 - 07/25/2020 07/26/2020 - 08/01/2020

1. Were you too sick or injured to work for reasons other than disaster? No No
1a. If Yes, enter the number of days (1 - 7) you were unable to work.
2. Was there any reason (other than sickness, injury or the disaster) that you No No
could not have accepted full-time work, each workday?
3. Did you look for work or contact your last employer, or, if self employed, Yes Yes
did you attempt to resume self- employment?
4. Did you refuse any work? No No
5. Did you receive disability, private income insurance, or supplemental No No
unemployment benefits?
6. Did you work or earn money, whether you were paid or not? If self- No No
employed, report earnings during the week you receive the money.
6a. Did you receive any other income this week based on work No No
performed?
7. If you want federal income tax withheld for the week(s), check the box to No No
the right.
8. If you had a change of mailing address or phone number, check the box to No No
the right.

Acknowledgement
I have read and understand each of the questions, and I have reviewed and agree with the answers to each of the questions I am submitting through this automated
system. I certify that each of the answers is true and correct for this certification period. I know the law provides penalties if I make false statements or withhold facts to
receive benefits. I declare under penalty of perjury that I am a U.S. Citizen or National; or an Alien in satisfactory immigration status and permitted to work by the
United States Citizenship and Immigration Service. I understand when submitting my request for benefits my submission is considered the same as my signature.

*You must indicate your acceptance of the statement by checking the box before your certification can be submitted.

94177 *Enter your mailing address ZIP Code

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