Forms & Pamphlets
- A Guide to Arizona UI Benefits
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Information Regarding Direct Deposit/Agreement for Direct Deposit (UIB-1091A) - Use this form to authorize the department to make automatic deposit of the full amount of any weekly UI benefits to your checking or savings account.
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Cancellation of Direct Deposit (ESA-1126AFORFF) - Use this form to cancel payment of your current UI Benefits to your direct deposit account.
- Certificate of Understanding (Eng/Span) (UB-99-Y) - This form is to be completed and returned only if instructed by DES Unemployment Insurance personnel to do so.
- Combined Wage Claim Withdrawal (UB-113) - This form is used to request a cancellation of an Arizona combined wage claim. Please use this form only if instructed to do so by DES Unemployment Insurance personnel
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Confidential Financial Statement (UB-92-A-FF) - This form is to be completed and returned only if instructed by DES Unemployment Insurance personnel to do so.
- Name and Address Change Request (Eng/Span) (UB-108) - Use this form to notify the Unemployment Insurance office of a change in your address and/or name.
- Report of Illness or Physical Disability (UB-296) (UB-296-FF) - This form is to be completed and returned only if instructed by DES Unemployment Insurance personnel to do so.
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Request for Reconsideration/Appeal (UB-126-FF) - Use this form to request reconsideration of or file an appeal to a Determination of Deputy or Unemployment Insurance Benefit Overpayment.
- Weekly Claim for Unemployment Insurance (UI) Benefits (UB-106-A) - Complete this form only as instructed by DES Unemployment Insurance personnel to do so.
- Work Search Log (Eng/Span) (UB-101-A-FF) - 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.
- Voluntary Election for Federal/State Income Tax Withholding (English/Spanish) (UB-433-FF) - Use this form to initiate (or stop) the deduction of Federal and/or State tax from your weekly Unemployment Insurance Benefit payments.
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.
