Forms

Unemployment Insurance

Authorization for Tax Withholding (Form 1040WH)

Available in English and Spanish.

Use this form to authorize withholding of taxes from your Unemployment Insurance benefit payments.

Authorization for Electronic Deposit (Form 117H2)

Available in English and Spanish.

Use this form to authorize the Oregon Employment Department to electronically deposit your unemployment or Work Share benefits into your checking or savings account. This is also known as a direct deposit.

Release of Information Authorization (Form 1826)

Available in English, Spanish, Russian, and Vietnamese.

Use this form to allow a person to request your personal information from the Oregon Employment Department.

Employment Search Record (Form 2554)

Available in English, Spanish, Russian, and Vietnamese.

Use this form to record your work seeking activities for each week that you claim benefits.

Initial Claim Application for Regular Unemployment Insurance (Form 115)

Print forms are intended for people who do not have reliable access to the internet or a phone. It will take longer for us to receive and review your weekly claim if you mail or fax it.

Available in English, Spanish, Russian, Vietnamese, Simplified Chinese, Traditional Chinese, Farsi, Korean, Lao, Somali, Amharic, and Arabic.

Use this form to apply for unemployment insurance benefits.

Weekly Claim Request for Regular Unemployment Insurance (Form 127)

Print forms are intended for people who do not have reliable access to the internet or a phone. It will take longer for us to receive and review your weekly claim if you mail or fax it.

Available in English, Spanish, Russian, Vietnamese, Simplified Chinese, Traditional Chinese, Farsi, Korean, Lao, Somali, Amharic, and Arabic.

Use this form to claim unemployment insurance benefits every week.

Unemployment Insurance Benefits Request for a Hearing (Form 2602)

Available in English, Spanish, Russian, Vietnamese, Simplified Chinese, Farsi, Korean, Lao, Somali, and Arabic.

Use this form to request a hearing on an Unemployment Insurance benefits administrative decision.

Overpayment waivers

Request for Overpayment Waiver (Form 129)

Available in English, Spanish, Russian, Vietnamese, Simplified Chinese, Traditional Chinese, Farsi, Korean, Lao, Somali, Amharic, and Arabic.

Use this form to request a waiver of overpayment debt from the state of Oregon.

Training Unemployment Insurance

TUI Application (Form 700b)

Available in English and Spanish.

Use this form to apply for the Training Unemployment Insurance program.

Self-Employment Assistance

SEA Application (Form 96-12)

Available in English and Spanish.

Use this form to apply for the Self-Employment Assistance program.

SEA Weekly Claim Form (UI PUB 2544)

Available in English and Spanish.

Use this form to claim weekly benefits in the Self Employment Assistance program.

For Veterans

Authorization to Disclose Personal Information to a Third Party (VA Form 21-0845)

Available in English.

Use this form to give the Department of Veterans Affairs permission to release your personal information to a third party.

Trade Act

Petition for Trade Adjustment Assistance (TAA) and Alternative Trade Adjustment Assistance (ATAA) (Form ETA-9042)

Available in English and Spanish.

Use this form to request benefits and assistance under the Trade Act of 1974.

Request for Determination of Entitlement to Trade Act Benefits and Services (Form TRA 006)

Available in English and Spanish.

Use this form to request benefits and assistance under the Trade Act of 1974.

Trade Act Handbook (UI PUB 350TRA)

Available in English, Spanish, Russian, and Vietnamese.

Use this document to learn more about the Trade Act program and its benefits.

Weekly Trade Act Benefit Request - In Training (Form TRA 8-58A IT)

Available in English and Spanish.

Use this form to claim Unemployment Insurance benefits while in training under the Trade Act program.

Weekly Trade Act Benefit Request - Not in Training (Form TRA 8-58A NIT)

Available in English and Spanish.

Use this form to claim Unemployment Insurance benefits while not in training under the Trade Act program.