Eta 935 Form PDF Details

Navigating the complexities of unemployment and transition after leaving a federal civilian job can be challenging, but understanding the ETA-935 form is a crucial step in this process. This form, officially known as the State Agency Identification Claimant’s Affidavit of Federal Civilian Service, Wages, and Reason for Separation, serves as a comprehensive document for individuals in the midst of this transition. It requires detailed information including the state agency address, the claimant’s personal and contact details, and specific details related to the claimant's employment such as the local office or call center ID, dates relevant to the employment claim (like the date of request, effective date of claim, and separation date), and the federal agency's name and address where the claimant was employed. Moreover, it dives into the financial aspects of the separation, requiring the claimant to disclose previous wages, possible severance pay, entitlements, and whether they're receiving or are eligible to receive a federal pension. The form also provides space for claimants to explain their reason for separation, a crucial piece of the puzzle in determining their eligibility for benefits. Understanding that this document is not just a formality but a sworn affidavit highlights its significance in the unemployment claim process, reminding claimants of the legal implications of providing false statements in pursuit of benefits. It’s a tool designed to ensure that transitions from federal service are transparent, fair, and legally compliant, putting a spotlight on the need for accuracy and honesty in its completion.

QuestionAnswer
Form NameEta 935 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameseta 935 print, labor eta 935, eta935 form, eta935 federal printable

Form Preview Example

ETA-935

( S TATE AGEN CY ID EN TIFICATION )

CLAIM AN T’S AFFID AVIT OF FED ERAL CIVILIAN S ER VICE, W AGES AN D R EAS ON

FOR S EP ARATION , ETA-9 3 5

1.State Agen cy Address:

2. Claim an t’s Nam e an d Mailin g Address:

3. Local Office/ Call Cen ter ID:

4. Date of Request:

5. Effective Date of Claim :

6. Separation Date

7. Federal Agen cy Nam e an d Address:

8 . Social Security Num ber

In s tru c tio n s : Co m p le te a n d Re tu rn Im m e d ia te ly

9. Affidavit of Federal Wage an d Separation In form ation / Docum en tary Eviden ce

a. En ter the location of your Official Duty Station : (City, State)

b. En ter your wages with the above n am ed em ployer below. Show wages by quarter startin g with the wages that you earn ed after (base period begin date) up to the date you separated from this em ployer . Un der Docum en tary Eviden ce, en ter th e source of the in form ation provided an d attach a copy. If addition al space is n eeded to explain reason for separation , attach your sign ed explan ation .

Quarter En din g

Year

Gross Wages

Docum en tary Eviden ce

c. Severan ce Pay. Did you receive or are you en titled to receive severan ce pay provided by Federal law or agen cy em ployee agreem en t?

_ _ _ Yes _ _ _ No If “Yes” com plete th e followin g in form ation : Total En titlem en t: $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .

Severan ce Pay Period Begin date: _ _ / _ _ / _ _ En din g Date: _ _ / _ _ / _ _

d . Pen sion : Are you en titled to receive a pen sion from an y bran ch of th e Federal Govern m en t? _ _ _ Yes _ _ _ No

En ter Gross Mon thly Pen sion $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .

e. Reason for Separation :

I, the claim an t, un derstan d that pen alties are provided by law for an in dividual m akin g false statem en ts to obtain ben efits an d that determ in ation s based on an affidavit are n ot fin al: that determ in ation s are subject to correction upon receipt of wage an d separation

in form ation from the Federal agen cy, that ben efit paym en ts m ade as a result of such determ in ation m ay have to be adjusted on th e basis of in form ation from the Federal agen cy, an d that an y am oun t overpaid will have to be repaid or offset again st future ben efits. I, the claim an t, swear or affirm , that the above statem en ts, to the best of m y kn owledge, are true an d correct.

10 . Sign ature of Claim an t: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Date: _ _ _ _ / _ _ _ _ / _ _ _ _ _

ETA-935

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When it comes to fields of this precise form, this is what you need to do:

1. To get started, when completing the eta935 federal form, start out with the section with the subsequent blank fields:

Step no. 1 in submitting eta affidavit

2. The next step would be to fill out these blanks: c Severan ce Pay Did you receive, d Pen sion Are you entitled to, e Reason for Separation, I the claim ant understan d that, Signature of Claim ant, Date, and ETA.

eta affidavit conclusion process detailed (step 2)

It is possible to make errors while filling in the c Severan ce Pay Did you receive, hence be sure you go through it again before you send it in.

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