Forms & Pamphlets for Unemployment Insurance

Complete one of the following forms to start the application process for Unemployment Insurance:

• Initial Claim for Unemployment Insurance - English (UB-105)
• Initial Claim for Unemployment Insurance - Spanish (UB-105-S)

Complete one of the following forms only if instructed by DES Unemployment Insurance personnel to do so:

• Weekly Claim for Unemployment Insurance (UI) Benefits - English (UB-106A)
• Weekly Claim for Unemployment Insurance (UI) Benefits - Spanish (UB-106A-S)

Use this form to initiate (or stop) the deduction of Federal and/or State tax from your weekly Unemployment Insurance Benefit payments:

• Voluntary Election for Federal/State Income Tax Withholding (English/Spanish) (UB-433)

Learn about Arizona Unemployment Insurance:

• A Guide to Arizona Unemployment Insurance Benefits - English (UIB-1240A)
• A Guide to Arizona Unemployment Insurance Benefits - Spanish (UIB-1240A-S)

Use one of the following forms to authorize the department to make automatic deposit of the full amount of any weekly Unemployment Insurance benefits to your checking or savings account.

• Information Regarding Direct Deposit/Agreement for Direct Deposit - English  (UIB-1091A)
• Information Regarding Direct Deposit/Agreement for Direct Deposit - Spanish (UIB-1091A-S)

Use one of the following forms to cancel payment of your current Unemployment Insurance Benefits to your direct deposit account.

• Cancellation of Direct Deposit - English (ESA-1126A)
• Cancellation of Direct Deposit - Spanish (ESA-1126A-S)

Complete and return the following form only if instructed by DES Unemployment Insurance personnel to do so:

• Certificate of Understanding (English/Spanish) (UB-99-Y)

Complete one of the following forms to request a cancellation of an Arizona combined wage claim. Please use these forms only if instructed to do so by DES Unemployment Insurance personnel:

• Combined Wage Claim Withdrawal - English (UB-113)
• Combined Wage Claim Withdrawal - Spanish (UB-113-S)

Complete and return one of the following forms only if instructed by DES Unemployment Insurance personnel to do so:

• Confidential Financial Statement - English (UB-092-A)
• Confidential Financial Statement - English (UB-092-A-S)

Use this form to notify the Unemployment Insurance office of a change in your address and/or name:

• Name and Address Change Request (English/Spanish) (UB-108)

This form is to be completed and returned only if instructed by DES Unemployment Insurance personnel to do so:

• Report of Illness or Physical Disability - English (UB-296)
• Report of Illness or Physical Disability - Spanish (UB-296-S)

Use this form to request reconsideration of or file an appeal to a Determination of Deputy or Unemployment Insurance Benefit Overpayment.

• Request for Reconsideration/Appeal - English (UIB-0126A)
• Request for Reconsideration/Appeal - Spanish (UIB-0126A-S)

Use this form to record all work search contacts made during each week in which Unemployment Insurance Benefits are claimed. Periodic reviews are conducted by the Department and you will be asked to provide (by mail or FAX) a record of where you have applied/inquired about employment during a specific time period.

• Work Search Log (English/Spanish) (UB-101-A)

The Department of Economic Security will provide quality and timely language services to customers with Limited English Proficiency to ensure meaningful access to programs, services and activities. To receive services in a language other than English, please contact any DES office.